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2008 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for CoeY of Marriage Record :.::::::.::.:!:!,,:::.:.::::.:':.:.:!.!..:,:,:.:!:.:::::.:!:.:::::::,:::::::::.',:.:!:::::::::::::::::::::::::::::::::::::::::::::::::::::::':::1::::::::::1111:::.::::8:1118,1:::III,=III::::IIIIII:':19!1:::::::::::::::::::::::::::::::::::::::::::::::.:::::::::::!:::::::::.:!:::::::::::!::,..::.,.:.: ...................... ...................... ...................... ...................... ...................... ..................... .................. ....... ......... .... .... Search and ~ Search and D $1 Certification \ i Fee $10.00 Certified Copy Fee 0.00 ~.. per copy per copy A Certification, an abstract from the marria record issued A Certified Transcript includes all of the items of information under the seal of the Health Department, incl des the names of occurring on the original record of the marriage. the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of groom. parentage and certain other detailed information may be required such as: passports, veteran's benefits, court A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate. :'::::::::::::::::::::::::::::::::::::::::::::::::::::::::,::::::::::::::::::::':::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::llIlil:::IIIIIIII::::1111::::111::::1:111:::111:::::::::::::::::::::::::.:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::,: .................................................... .......................... ........................,. .......................... .:.:.:.:.:.:.:.:.:.:.:.;.:.:.:.:.;.:.:.:.:.:.:.:.:.: .......................... ................ .......... ;.:.:.:.:.:.:.:.:.:.:-:.:.:.:.:.:-:.:.:.:.:.:.:-:.-. PLEASE PRINT OR TYPE Name (First) (Middle) of \ \ ,.. i '.' ! Groom;, \ C I, LlC I Groom's Age or Date of '2. II '"1..' I c. Birth '. .J J'U LP Residence (County) (State) of . <: ~ ,i. , ,,/I /1 N' \A Groom /) l 1A;;;/ ljVUAYJ l L; , -I Date of Marriage or Period Covered by Search Place Where License Was Issued 1 (Last) C' I \.l-lN Name (First) (Middle) of Bride Bride's Age or Date of I. .\~ Birth V ("T I Lv Residenc~ ( ounty) ~fride b lJ..,tC//1C SS If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (State) A/~ . (1 ~ .\ 'J....... For what purpose is information required? What is your relationship to person whose record is requested? If self, state "self." - ~v't -s,1J...,);;L~ In what capacity are you acting? ~Ll+- If attorney: Name and relationship of your client to persons whose marriage record is required. Please print name and address where record is to be sent. ,'? I (""" , ")l 'JL~(jl/l G'\.. "l.f2P' f--{7t II ~ (L . N~l I~) ~tJ D S CUIl') e .,ECEIVED DOH-301 (3/93) DEe 3 ;i 200~ (PLEASE SEE REVERSE SIDE) T(),^, " I t;I l=RI< .i:.~~r~ DRI\ER LJCE~SE 10: 224 732 502 8_AS~ D KEARNEY.CHITTY L ;$4:;StIClCH PlACE ~NGER$;Fl.SlNV 1'2590 __: 06.29-* SEX F EVES MAW.5-02 E 'NONE f:B ISSUED 07.09-08 EXPIRE; 0&-2\-.-1 E . -. -- KSJSEZFJ19 , 0 . ~C'2.\\Je Application to Town/City Clerk ~:'R~:~s~:C~~~EPARTMENTOFHEAL~ f" t~~% for Co of Marria e Record 1" D Fee$10.oo per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. Search and Certification A Certification may be used as proof that a marriage occurred. rvFee $10.00 ~ per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. _j:lt~~LfJ:C;!:;.';';~::::;~;;?;i; ;:\', ;'~ ~:~:~:::~:::~,:,:;:::,"":,,:!":, : :':' "~ :", ',,' ;" ',~,::,:,:::v:<::~,'::~'<:~:,:tv'" <,:~i ,::::<::'::::::~;:~jlr_~I~i1f;I~i.. PLEASE PRINT OR TYPE Name (First) ~room C hGtrlcs. Groom's Age or Date of Birth Residence of Groom lA,fV'f'- NOu.."A.) Date of Marriage or Period Covered 0'2 -O~-- \ 972 b Search Place Where r ~=was l{JArr \' ,1..)''( (<; 7Zt \ Is) (Middle) If- (Last) 2VV\ ~'c~ (0 '-lct - lq':) l (County) (State) For what purpose is information required? (1 (\ hi Li I VY\ -e A)t-- In what capacity are you acting? p eT'\ -H 0 JJ~r:... Name (FII'St) of M Bride ' A~ Bride's Age or Date of Birth Residence (County) ~ride Co \\ I If Bride Previously Married, State Name_ Used at That Time P~Where <;" _ lV\aJ2.-4' \ Cf,,,...{,'2-c L Mamage Was , __ Performed I \ \ I J '- (Middle) (Last) M fjRIol\fL't. T N\ ER.G.}..J \)O,()\ O~ -- 20-1 'f'-) ~ (State) IcS Y-..A ~ V\Ihat is your relationship to person whose record is requested? If setf, state -setf.- ' S''CLF If attorney: Name and relationship of your client to persons whose marriage record is required. , astey 2300 McDermott Rd $le, 200-364 Piano, Texas 75025-7016 Please print name and address where record is to be senl M, Hasley 2300 McDermott Rd $le,200-364 Piano, Texas 75025-7016 DOH-301 (3/93) ,', ~'. ";:",1i,, 'o:CU].~fil:"Z\~ ~,if6t'(ftr,~ ;i!;';~) C!I~-11 ,f.:!tl~..L~{~,":j~;'Y'(lf. .' C~J~'!.:f'~.~.~:~SE f 7 ~O"{AI1).- \,\ , .',~_n',~:~. ~~" ({ * * * ) ~,k:~.;,:.,' ." ..._u.. \ \ A ,,0)0' ~:..... UB~ ~. '/ .' ';'" '" , ,,;j (,f '-Q. 'l "0 1_ 1 \.- "1-'t~ ....._~ -.......l '3', ,";.; ,~.~"~_"',!:; .~,~~" .............~.COU"'\ ' December 16, 2008 Town of Wappinger Town Clerk's Office 20 Middlebush Road Wappingers Falls, NY 12590 Re: Request for Marriage License To Whom It May Concern: By this letter, I am requesting two official copies of my Marriage Certificate to be used for an annulment. Following is information that may be helpful: Name before Marriage: Mary Margaret Merendoni Name after Marriage: Mary Margaret Merendoni Emich Current Name: Mary M. Emich-Hasley Name of Former Spouse: Charles H. Emich Date of Marriage: February 5, 1972 Place of Marriage: St. Mary's Church, Wappingers Falls, NY Enclosed please find a notarized form per request and a check in the amount of $20.00 for two copies. If you need additional information, please call me: 972-345-3891 cell phone. Thank you. Sincerely, ~-0~ Mary M. Emich-Hasley 2300 McDermott Road, #200-364 Piano, Texas 75025 Enclosures . 3548 LLOYD A HASLEY MARY HASLEY 2300 MCDERMOTT RD 200-364 PLANa. TX 75025-7016 ---- ~ ~~~:~ . WelI.FargoBank,NA ,- ~ F~ ~{~~~ .01,'1550020'1";- oisl,a- ~... . 37-65/11192390 0495500209 12.-/(~/o~ I Date I $ ~O."'"(, a Sec~"ly Dollars W ~in~,',e~n ...;)M> RECEIVED Application to Town/City Clerk for COe}' of Marriage Record NEW YORK STATE DEPARTMENT OF HEAI-TI-ll 1 2008 Vital Records Section Search and Gj Certification .' Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy D Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed i~formation may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. PLEASE PRINT OR TYPE Name (First) (Middle) ~room ,:JO h n ~ p, Groom's Age . or Date of '7 /1'3 / ,55 Birth Residence (County) ~room D lA-te-Aess Date of Marriage or Period Covered by Search Place Where License Was Issued (Last) Vd-o..(e. (State) NY I~ I Vltl/ 0'1 70 vJn of' IN (tpPf"'3.e r..s Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name C/i/I u, n Used at That Time tA Place Where Marriage Was TO<..uY\ 0+ Performed (First) (Middle) (Last) Mo..nctn()e Dolores u:zi/aY] rt/ 2~ /5'1 (County) ]) LA- fr!.j, e S3 (State) N /rJo... f PI1?j< r S For what purpose is information required? VI alY]f C Aa.f1se- In what capacity are you acting? Sel'P What is your relationship to person whose record is requested? If self, state "self." s -e. (+ If attorney: Name and relationship of your client to persons whose marriage record is required. Signature of Applicant. - f) '-/Yl cuu_~, U~t'CLilJ Address of Applicant 09 Pou Camc./o-f Rd h f{ -eQ ps if: /lJ Y I 2lctJ I DOH-301 (3/93) Date IZ/I/OS? Please print name and address where record is to be sent. 12ho (PLEASE SEE REVERSE SIDE) ID:227172 758 <'--, DrtT\"ER L1CEXSr I' DOE:Q8,;~~ ,... ~~,'O .~- "pOflGMKSEPstE ..Wt't26. SEX:1?E'I'~'B~LiMt:... . CLASS. 0 ~E. .....'. '~" i......, J8SlJEP W-'22i003~E$:'!I8-"'1 ~<t)~ .54019310 "- - __:''''<"'''-w'.~C;:':..-.-..,....,;..<4:.,_....__~,.,..,,. . ...oJ' Application to Town/City Clerk for Co of Marria e Record ~earch and Certified Copy Fee $10.00 K per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section D Fee $1 0.0~ ~CLE A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. Search and Certification A Certification may be used as proof that a marriage occurred. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. PLEASE PRINT OR TYPE Name (First) (Middle) ~room \AI t\Ari Groom's Age ~~~ate of l \ - 2- q ,-~CJ Residence (County) ~room 5(P L~ t2 Date of Marriage or Period Covered by Search Place Where License Was Issued (Last) t>e- lltSo (State) dY' . (Middle) (Last) Thrt\ed~\\\ C~V't\l Name (FirSr ~fride N l'C.-O :f. Bride's Age o~ Date of I \ -l f{ -7 S Birth Residence (County) ~fride 5 ~ L- Cc { L.e If Bride Previously Married, State Name Used at That Time Place Where Marriage Was ,^, Performed V v (State) G kl'aJ dY'. ets 1r> ()) '^- 1A~ II F~t:;rst~~ In what capacity are you acting? Sign~.of Ap 'can Addre6~AZI~n~-e ~Vt-t~cI dr yV4.r? l'~-;j ef'..s 4 ( I ~'II*257 CJ DOH-301 (3/93) What is your relationship to ,PF\son whose record is requested? If self, state "self." ~ e- ~ If attorney: Name and relationship of your client to persons whose marriage record is required. Qrt () 8 Please print name and address where record is to be sent. (PLEASE SEE REVERSE SIDE) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for COe>' of Marriage Record . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . .................. ....................... . .......................... ........................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .............. ...... .................................. .................................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .............................. . ........................... ........................ ................. Hj:j:jj:::::::::::::::::::::::::::::::::::::!:::::::::.:.::::::::::::::::::::IIII!::.:j::I:IIII:I:::IIIJ,llg::::tlflll:::IBI:::::j:::::j:::::::.:.:::::::::::::::::j:::::j:::::::::::j:::j:::::j:::::::j:::::::::.:::::.:::::::j:::::::.:::::::::!:::!:::::!:j:::::::j:j:::.:.:::::::::: Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. ~ee$10.00 ~ ~~rcopy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. Search and Certified Copy A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. .::::.::..::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::1:11:111:::_1181::::1111::::111::::1:111:::111:::::::::::::::::::::::::::::::::::::::::::::::::::::j:::::::::::::::::::::::::::::::::::::::,..:::::::::::::::::::j::::::::::::::::::::::::::::::::: PLEASE PRINT OR TYPE Name (First) ~room EtJCmE [. fJ/(IMI2/JSE Groom's Age o~Dateof /1 - I - (; ;;; Birth T Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was Issued (Middle) (Last) (County) (State) j)f/1CIIE~ AI Y 8" -/:3 -11 J1;,4I!//IIc;at; FALL~ Name (First) (Middle) ~fride !Jl:! /2tlltE A ,#I/LjJ)/Y Bride's Age . o~ Date of I L - l.s - ~ jL Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (Last) (County) (State) /II OLA.N6'~. i(//A ' J3EUEJtt1SE / IVy For what purpose is information required? 7P 1/5 E FlJ R LI CE.7V'''5E (IliA NS-.6 In what capacity are you acting? D /if l3E711t ~~-- D F M YSEZ.-r f i j1/tJtJ tJ yY/) /;; 1/V6 E72 5/ #< T / 2~9l) DOH-301 (3/93) What is your relationship to person whose record is requested? If self, state "self." 5t=L;:: If attorney: Name and relationship of your client to persons whose marriage record is required. Please print name and address where record is to be sent. ~D,.ede .MtJ,RPAY. YS'WO t? /) Uh1/j/ (> T ?II' f7 //Y&E7Z;' /fi 5 9~ (PLEASE SEE REVERSE SIDE) 10:836 021 382 ..........,..'."",.. ",:~..,~~ ~ .,: ':.i" 'I DmVEn>LlCfN~m I I ) , DaB: UH5-64 MV~Pt1Y,Ot;IRDRE.A 45 WOQOI-ANO COVRT WAPPIN~fER' FI.-S NY 125\j~ $EX: F EYIii$ Pft HT: &,of CL.4SS: D' E:R: ISSUED: 1o-~exPIRES: 12-15-11 ~~ ~90 Application to Town/City Clerk for Coey of Marriage Record NEW YORK ~TATE DEPARTMENT OF HEALTH Vital Records Section Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. Search and Certified Copy D Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certification may be used as proof that a marriage occurred. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. '::;:::::::;:;;:::::;:::::::;::::::::::::::::::::::::;:;:::;;:::;:;::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::;::&i1::::E]f:.....::S.......:::ri.iUjrn:~::e+..E.......::::Bnft.M...::....::::Jfii......:::;::.......:.......:.....::................;::E........S........::::::::;:::;:;:::::::::::::::::;;;::::::::::::::::::::::::::::::;:;:;:;:::;;;;::;:::::::::::::;;::::::::::;:::::::::::::::::::;;::::;:::::::::::::: ::::::::::~::::I:~:~:::::~~~::::~:::::::::::r::::::::::::~~::~::~:::::j:::r::::::::::::::::::~~::::~::::~:~~:~:::::~:::::::::}::::::F:9E~I:;.:.:.:::Sfflfl!HtEE:J\.;.::t:n*g;.;:;:;:J::M~;!~~~~B~s:.:::.::::m:::rt!:;.:.:.:::~::::::::r::~:::::::::::~:~:~:::::::::~::~:~::::::::::::::::::r:}::::::::::::!!:!::::::::::~:~::!::~::~::::::~}!::::::~:::~::::::::::: PLEASE PRINT OR TYPE Name (First) (Middle) of Groom Groom's Age or Date of Birth Residence of .\ \ \ . Groom H"t' <: '. "\C .\...../'-/ Date of Marriage or Period Covered (~ ~S~reh 1 Place Where License Was Issued (State) . f~ Y (State) ~)A:- Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (First) 1Y\((.v"l \ lit ~S (Middle) (Last) (vI e l 0 . (County) I"" I I --..:....-\;... \C ,,^,C \/i \ N For what purpose is information required? I~:{ .(}A~Y)i:) " A- . What is your relationship to person whose record is requested? If self, state "self." . () . ~.\..k- I I \ L) If attorney: Name and relationship of your client to persons whose marriage record is required. In what capacity are you acting? Address of Appl" ant ,-\D I vJl L 9 (\ ~('?4. C'C u YV' v'llO"'7 J P I!~ \ to 0W b Please pr" t nam and address where record is to be sent. DOH-301 (3/93) (PLEASE SEE REVERSE SIDE) CQmJMed astr: '/' Issued: 05/08/2008 E>:pires: 07/30/2012 - (2J~ ~~ RICHARD JOHN KOSUDAJ 401 WILD CHERRY CT MARS PA 16046 . No: 19 750 41 2 Dup$l: QQ OOB: 07/29/1962 Sex: M Class: C Eyes: ~RN endorse: ---- Height: 6'01" -IB , NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for COe>' of Marriage Record _#J::V/X'/://.' '/.:;;-,Wu "'-f'",,/. U .~,' ./. ,',..' , ',. ,.. '." .. .;.",' ;x~;",,,,, %,.'u ",;-,.,. .;.$?^' ""0.'w'<<;/."/{%.;1W_~II' %fj;-?.Jk:t t' ~]8"~~t:.' .", ~ d;" ;=" ~ . r : ~ /~ ~.~ ::':~;;:~/?~:~j~~~~j)t)%x....;r1rt1M~~{.ff;: ~ @L.N;,::r{?::"::;;:..%.llit&%::"~-:..., ~-'/.~ ::..%';:::- .... ~..~:;/ ~ <' r ... "', ......::~:". /~...?/ : "z- "'/N;(.'*'-:%"'Z':;;'N~;{X':-'.:...x:;.)z:i:w%:r~~y%Y.::;.~;;:z:::::W*"~ Search and Certification Search and Certified Copy f\:i( Fee $10.00 ~percopy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. D Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certification may be used as proof that a marriage occurred. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passpons, veteran's benefits, court proceedings, or settlement of an estate. ~Wi&1Wfi~~1;f7~:ffr3!r0t<~fr'" ;':" u' .'~;-.; J; "'~Y.:: :"" ':: '. ." .....:.. uY:C',""'" ';.':.'.:< ,:~;:::?"i1;*,j;ff;~It.~J:';;rI4f~Ktim~ m=~ [&..&:...:::;;.:<<:-::::::::-..0/..,.../.%..... ~N*ffi..z::{--:.....n?>>.-:{-:.t' . .. ~-: . ~ InI'.. ...... ,N. ... .y." .. <'. .... ......... .. .. . .'~" ...........~.,. "., .x... ...;x,.).....:......>%...:N... ..../.~..;.:-'.,",.x::i:?...:,..;.x._i~ PLEASE PRINT OR TYPE Name (First) (Middle) ~room VV\ LC VtlU' I ~r Groom's Age ~~ateof O?/1S-q Residence (County) of /I . h' Groom LA. tA....1!.A vt. pt.t:<- Date of Marr or Period Covered Search Place Where Ucense Was I A . Issued Vv t:t (Last) Name kok~~{.er :ride Bride's Age or Date of Birth Residence (County) :ride U V't U I/L ft.//... h' If Bride Previously Married, State Name Used at That Tme Place Where Mamage' Was I L --I _ Performed ~v A f71J t Vt S -fA/S ~ t L S I (Fnt) 5l-tu vdY') (Middle) (Last) 1A.ACt/V, e. ~ I () h Or / 1 ~ / (State) et-J. p For what purpose is information required? ttw::rl!:L~Ctr:~ \Mlat is your retationship to person whose record is requested? If self, state -self.- XdJ- In what capacity are you acting? If attorney: Name and relationship of your client to persons whose marriage record is required. Address of Applican II I tI a"vJ..s.vr II e e..vu VtA a-v/ ']/I e.vu bU. Cv); I I?-rrvo u.. i k I t1A /I- Date lL II OJ' Please print name and address where record is to be sent. S ~ fl..d. 5haron kokoek;-- O/~O <f!- LS~UMe-. t:lddi'r M ) DOH-301 (3/93) (PLEASE SEE REVERSE SIDE) p \>\>~\\\\y".~..,:, \~,I :~==_---L~ . SSAICHUSETTS lJRimtSJ.:fCBNSC\ NUMBER 377898967 (-- ~ A!XP"', "",' , .DDB .< '~..;t;"2012 07 -14-19i . 'Ci<ASS ;HESTHGT SEX " ",:J; o ' &-00 F ,.- KOKOE'PiER ~;, SHARON'M ' 111 HARTSVILLE NEW MARLBOROUGH'~P GT BARRINGTON, MAJiif,l. ;'iT 01230,2037~llfl". \ ".' ":.'Z<;- NEW YORK STATE DEPARTMENT OF HEALTH V,ital RecOrds Section Application to Town/City Clerk for COe>' of Marriage Record Search and D Fee $1 Search and D Certification 0.00 Certified Copy Fee $1 0.00 per copy per copy A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information under the seal of the Health Department, includes the names of occumng on the original record of the marriage. the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of groom. parentage and certain other detailed information may be required such as: passports, veteran's benefits, court A Certification may be used as proof that a marnage occurred. proceedings, or settlement of an estate. ::..":::::i::::'::i:::::'::i:ii::::i:::::::::::.:::::::::ii:::i:i:::::i:::i::::::::::::':':ii:i:::::i::::::::::::::::::::::::::::::::::::::::::j::IIIIII:jiI1l85111:jj:illli:::IRI::::I:Ii.li:illl:ji:iii::::::::::iii:ii:ii:ii::::::i:ii:::ii::':i:j:ii:::'::':::.::::::i::j:i'::::i:i:ii::::::. . . . . . . . . . . . . . . . . . . . . . , . . . ........................ ......................... ........................ . . . . . . . . . . . . . . . . . . . . . . . . . .:.;.;.;.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:. ................................... PLEASE PRINT OR TYPE Name ~F st) ofF. / Groom E t/ f/l/ Groom's Age / / ~ or Date of ~ Birth Residence \ (County) (State), ~room -f-)(/-O de' 5..:s AI\ . Date of Marriage / ~ or Period Covered fj I /i '?-c7 0 -.3 by Search C Place Where /'/. . UcenseWas ~ I,r/J~/I(/r/~&~-S' //Jc. ( ~ Issued (/1/ /-Jr f '7 (Middle) ~Fir~). ~iddle) Bride .LJ c Db I L- /~ Bride's Age or Date of Birth Residence (County) of ; -h'~/~' Bride / v/ c..rrE~..:> If Bride Previously iJ Married, State Name . d LJ . /:::- Used at That Time G /:').0 1(.. Place Where Marriage Was . ~c,v':; Performed '(j/C (Last) At.. /4/v/( Lit (State) j[/Y' ,A:/Y For what purpose is informatioZhired?.. . 1/. P --1 /~L--2>/ rffL ";Jvc0<=:. /J9 c:::- What is your relationship to person whose record is requested? Ifself'~Jr In what capacity are you acting? ~L'Z r If attorney: Name and relationship of your client to persons whose marriage record is required. Please print name and address where record is to be sent. ,/t/j/ I d.-603 RECEIVED DOH-301 (3/93) (PLEASE SEE REVERSE SIDE) TOWN CLERK . NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for Coeyof Marriage Record, Search and D Certification Fee $1 0.00 per copy A Certification. an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy D7l Fee $10.00 l.kI percopy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. PLEASE PRINT OR TYPE Name (First) of -r Groom ..j L\ S 00 Groom's Age or Date of Birth Residence of Groom 0 If (.\ (\ ( (: Date of Marriage or Period Covered .' 7 I ) 0 0 I) b Searc.h t c, t '7 1.- () Place Where -r: License Was I D'>i\j{\ (~ \\j'.\PIP\\'~Y Issued . IN (I C' tn:... (Middle) .s 'f(y ,e Y\ (Last) Ko{; (\ 10 ZC6... lC/1,; (County) (State) HOllet\.. For what purpose is information required? ?~'\S0 ~Ol'+ n(,\(f){. (\'\(\\\()(~. In what capacity are you acting? ,~ elP Signature of APP~ica. nt J.... .f.' .~ ~\I!l Address of Applicant gLt 5<j-- Nc\v',' l) 0$';;( C *-)C\ o r\ {'\1 cl () I r lr 3 2t61.1 o NOV 0 6 2008 TOWN CLERK Name of Bride Bride's Age or Date of Birth Residence of Bride , If E)p:~~a Previously Married, State Name N A Used at That Time ~I~ Where "'0 V\J Ii oF \1\1 0, P 17 \ <\.D...,o V Mjrr:u~ge Was " U ~ Performed" We\' \ J f' If c;. (First) \J \. (Middle) Let (Last) 'l\b~tk ll'1\{\ o c - 0 l~ I '1 ~ 3 (County) OV-(~\ft{ e. (State) Hoy;di\. What is your relationship to person whose record is requested? If selt, state "self." ~~ If attorney: Name and relationship of your client to persons whose marriage record is required. 10 17; I O~ Please print name and address where record is to be sent. n.. .SOrl "'.\/. \(d'jv\\(,- Ko 1;.1'\ , ~ 'I D II Av. -t !121'.)":J- qlfl;-=r ,~(W A)OCs:-e.c. (1'<0 r'lr I Or' 6V'\C{ 0 t=t/ -:;2.st2.q.. (PLEASE SEE REVERS flOIEltT NUWI NIeIry PullIIc . ..... of ,.... . J .., COlIINIIIon e...-1IIIr ,.. ., , COlMIIIIIOn . DO 753143 . ""~ ", BondId l1lftluIIl NlllDMlNaeIIy MIll. 10/31/0 ~ RECEIVED NOV 0 6 2008 TOWN CLERK NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for COe)' of Marriage Record Search and D Fee $1 0.00 Search and [3 Fee $1 Certification Certified Copy 0.00 per copy per copy A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information under the seal of the Health Department, includes the names of occurring on the original record of the marriage. the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of groom. parentage and certain other detailed information may be required such as: passports, veteran's benefits, court A Certification may be used as proof that a marnage occurred. proceedings, or settlement of an estate. PLEASE PRINT OR TYPE Name (First) of C' \' Groom L \ ~O Groom's Age o~ Date of Coin 11 Y Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where 'OW License Was ("'\ Issued (Middle) (Last) lo(:Q..~ (County) \)()~Qb~ (State) ~~ tDj4 J Ck c, ~Q0~~ \=c..\lS For what purpose is information required? OVYJ,C'Cj ('.{:J;.~ In what capacity are you acting? e~~A~~~\Q.~ l.~ ~\N:f!S> ~\\~ ~'{ \G5<10 DOH-301 (3/93) Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed ( First) ~\~ (Middle) kin Li/llflY (Last) ~('h. (County) '""D.)~~~ (State) Ny What is your relationship to person whose record is requested? If self, state "self." ~ \{ If attorney: Name and relationship of your c1i whose marriage record is required. /o-JLJ-ov Pleas~:0 an~sz....where record is to be sent. 2.1 ~u\~~ lu\J.- l...)o..QQ'~ ~ 1=cl\~ N'-( 12..SQ u (PLEASE SEE REVERSE SIDE) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for CoeY of Marriage Record ... .............. ....... ..... ....- . ~!~.::~::~:~:::::::~:::::::.:~:.:i:::::::i:::::::::::~::::::IIBI:::II:::jl:lgll:l~j:III"III:~::II_I:::I.I:::i:::::~:i:~:::~:::::::::::i::::~i::::::::::::::::~'::::~::i:i:~:::::::::::::::::::::::::::::.:.:::':.:'~.:::::::::::::::::::::i:~:::::::::::j:::::::::j:. Search and D Fee $1 Search and B Fee $1 Certification 0.00 Certified Copy 0.00 per copy per copy A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information under the seal of the Health Department, includes the names of occurnng on the original record of the marriage. the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of groom. parentage and certain other detailed information may be required such as: passports, veteran's benefits, co~ EO A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estateR ECE. ?~\Ul': ljl \ ~ ::::::::::::.::::::::::::::::::~:::~::::::::::::::~~~::::::::::::~:::::~::::::~:::.::::::::::::::::::::::::::::::::::::::::~::::~:~:::::::::::::::I:I.li::.lllill::::IIII::::III::::B:IiII:::III:::::::::::::::::::::::::::::::::::::::::::::::::::::::;:~::~:~:~:::~:~:?:::::::~(:~::I.::::;:::::::::~::::~:~:::::~: PLEASE PRINT OR TYPE Name (First) of Groom Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was Issued (Middle) Qf\C J O~\t~\ 11 (Last) wooA~ c\ (State) N--A For what purpose is information required? . tQ)~--\ ~r< ?;r ~ ~ ~~ . In what capacity are you acting? (Last) . Gld6-l~ Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married. State Name Used at That Time Place Where Marriage Was Performed (State) tJ~ --- --- What is your relationship to person whose record is requested? Ifself,s~r {) If attorney: Name and relationship of your client to persons whose marriage record is required. ddress of Applicant .. 35~T ~'(\ Vl eLCJ1::J\ J Z ~~\~~\S\~.,\ \L:'\40 DOH-301 (3/93) IO{<.{O~ Please print name and address where record is to be sent. (PLEASE SEE REVERSE SIDE) " CL.ASS D ~ <IlIFl flJ i't2S90 , .ORGAN'J)ONOR (iSl!k: <F EYES "'" .~i.,'.... 'T ~NGNEIIiiiIii.. .R'N0NE 1. " -.;,~ ~ ISSUED, 05-13-08 EXPIRES 08-27-11 121I7_ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for Coe,y of Marriage Record Search and D Fee $1 Search and D Certification 0.00 Certified Copy Fee $1 0.00 per copy per copy A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information under the seal of the Health Department, includes the names of occurri~mm of the marriage. the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of groom. pare~tage:al'1d cett. detailed information may be required such as: s, veteran's benefits, court A Certification may be used as proof that a marriage occurred. proceed~e~ an estate. PLEASE PRINT OR TYPE Name (First) of R Groom . '/IJcJf'(D Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was Issued (Middle) (Last) .---- C I CJ7IJ-Se.. rJ A /0 -cJ.d. - L/O (State) ,/1 If €uJ/tJAA (County) b lI1!ch-e-ss d-Ir-~L, For what purpose is information required? S"~~~ In what capacity are you acting? Name of Bride Bride's Age or Date of Birth Residence (County) of ~. -- l (1 C' Bride J..) t11 c-n...e::::....;> If Bride Previously Married, State Name Used at That Time Place Where m I Ch Marriage Was 5' f, A-~}/S Performed /' . (First) D/7-U.}!{ 4- (Middle) (Last) .e#JY t;4N/V q-/)~lj~ (State) N-eu)oJ<!< What is your relationship to person whose record is requested? If self, state "self." 5 f? I r If attorney: Name and relationship of your client to persons whose marriage record is required. DOH-301 (3/93) Please print name and address where record is to be sent. (PLEASE SEE REVERSE SIDE) Application to Town/City Clerk for Co of Marria e Record Sear~h and SEP 3 0 ~ Fee $10.00 Certification ,jercopy A Certification, an abstract frO~~MJJi~~rd issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. ./ .. ,~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section A Certification may be used as proof that a marriage occurred. Search and Certified Copy D Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. ::::,::::::::::::~::::::::::::::::::::::::::::,:::::::::::::::::::::::::::::::::::::::~:::::::::::::::::::::::::::::::::::::::::::::::::~~:::::j:::III.i:::I.II.1::::1111::::181::::1:1111:::111::::::::::::::::::::::::::::::::'::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::j::::::::::::::::::::::::':::::::::::::: PLEASE PRINT OR TYPE Name (First) ~room 1ZD oc A- Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was Issued n (Last) vas C-D (Middle) W :L - <J.. ':J- - if 1 (State) c~~ NY l-fO-Qr (County) (Middle) S ll-2-4-4q (County) tLrrh~ (Last) tv\ch-k (Y)Q y\ Name ... (First) ~fride L \ n..d fA Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (State) N Phd l ( ~ Fae;;t~e ~rhusibd~ruL In what cap,aci}\\are you acting? \AI { +--L ~ What is your relationship to person whose record is requested? If self, state "self." 5.e../ + If attorney: Name and relationship of your client to persons whose marriage record is required. DOH-301 (3/93) Date q- 30 - () ?l (PLEASE SEE REVERSE SIDE) 10/l!ih'2008 10: 11 .. 8454514944 POUGHKEEPSIE PE DEPT ....~..:'. .:..' ".' w.... ".. ::....: ,:. ":';')'. l. .:.......'. ].(j.......~. ....;,:;.'5......:.. ".I0I:'..........:......F\..:.: .'.'..':.m'\.*.....~...:...~: '. ..... . ,'! "0' ..) '--. it,'- ;' '..:..... .) ~;. .... ! . .. . " . '.. . ~ . '~" '.,' -J ., . ..... . '.. '. I' ...~~ '~"":.'-"..: <.}:~::..,:,.....;.:..~~~).: :... . Ct,"'~I"'!I~I~r.~h:.~OI~11.~t>RI\;1ER,:Ll€~NSE . 10-"0&200;_ . '.' . . ........, . .. .... .... .c. .... c.... .~I/~1$!~ '1 \ '~',: II.:. o~~ # dYc2-~lJ~ (i v PAGE 01 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for COe)' of Marriage Record Search and rn Fee $1 Search and D Certification 0.00 Certified Copy Fee $1 0.00 per copy per copy A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information under the seal of the Health Department, includes the names of occurrrng on the original record of the marriage. the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of groom. parentage and certain other detailed information may be required such as: passports, veteran's benefits, court A Certification may be used as proof that a marrrage occurred. proceedings, or settlement of an estate. ............,........................ .................. .. .................. ... ............. ................... .................. ................... ... ......... . PLEASE PRINT OR TYPE Name (First) . ~room It \; ( f) Groom's Age or Date of Birth Residence ( ounty) ~room l1t~e ~ Date of Marriage or Period Covered S 1 by Search U Place Where License Was Issued (Last) ~l N/fc G.l ti.l4€.-'1J (State) I\J ~, 2<Jc;f} . Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (Last) ( ounty) (State) \.Itch e5 J \J ~ - 5 ~ (' tk\ 0 I t\ rn. e "'-J ' For what purpose is information required? \jJ ~ F ~ N~QJ~ t \ fCtr r\L)~~((?, In what capacity are you acting? What is your relationship to pers3P- whose record is requested? If self, state "self." S ~ , I If attorney: Name and relationship of your client to persons whose marriage record is required. ~!. ll:J()1 Please print name and address where record is to be sent. DOH-301 (3/93) (PLEASE SEE REVERSE SIDE) ~\.I;.:.,.t.J/.J!th:,'~;, '.:."....:.. ,.,~~,~ .., Q~nl Application to Town/City Clerk for Coer of Marria~e Record NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an state. ED 6 PLEASE PRINT OR TYPE Name (First) of "7 ~ Groom c.:;(\u"\ Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was Issued (Middle) D ~ / G /7/ (County) \ (jl~ '> 0/ 1)/ gr W4Qf\~~ (Last) 5'~\~ ~ (State) /J~ \. Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (First) Av\~"" Ik yY1 F/3/70 (Middle) (Last) eaSs I r (County) \)J.c~,... ~ (State) )J.'- v\~,w M~~ For wha~pose is information required? V I\t:~+- l2~r0SJ- In what capacity are you acting? What is your relationship to person whose record is requested? If self, state "self." If attorney: Name and relationship of your client to persons whose marriage record is required. /1 - WII/',,~) Y-. /V,\. IZ)Cf DOH-301 (3/93) ,- r IS/' fill Please print name and address where record is to be sent. 'jCf -t,.v,lllCofI1.S 5\. ~,h./(t(( v<.A Y \ ').. c;:l Y (PLEASE SEE REVERSE SIDE) Application to Town/City Clerk for Col!}' of Marriage Record NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's b~VED proceedings, or settlement of an estate. t'\t:.V'-' ::::::::::::'::::.,::::::::::::::,::::::::,:::::::::::,:::::,,::::::::::::::::::::::::::::::::::::::::::::::::::::':::::::::::1:.111:::11111119::::1181:'::111::::B,:III:::~EE:::::::::::::::::::jjj:j:::::::::j::::::::j:j:j:jjj:::::::::.::":;:;:::",:};:,,::,,::,,,,:},:;:::;:::::::;:::::::::,::::::::::::i.i:::::::: PLEASE PRINT OR TYPE Name (First) of Groom i a Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was ~\/I) (I .,f L/lb.. Issued I Uu- v (Middle) (Last) ore flrl 0 "7 I Cl..y1I 5/IY177 (State) y,- (County) DvJch.9C;5 For what purpose is information required? S:JC(' eU Y C 0.-/1, (- Y I In what capacity are you acting? Address of Applicant 3 ;:>5"t!~ {l Jntt- r- :'.' J1-Ih; l \ .. r-f3lt./!VJ'le'L~ (, (K /l \)./ _A../-( I d c) d-~( DOH-301 (3/93) (First) (Middle) C\ I .::x:uof " na (Last) 'tWO( f Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where MarriageWas ('; 1 ~ flf /0 .c' / 1/.."r7,;;r:. C-. Performed . -( C ( u (Jv 1//7 t I/--'r y U?~ ?3/)'/77 (County) C/lf!c; )" (State) pY What is your relationship to person whose record is requested? If self, state "self." '7€(f If attorney: Name and relationship of your client to persons whose marriage record is required. C/o r::;/ iJ [( Please print name and address where record is to be sent. See lQf/' n c, 13 ,-E' (v, ~il --:2 Fl S V) {~ It t (,1..(... i) y' . :;> r'"" 0/)' t ( . , ~/ <) '0/<. ( l l );).. 't (PLEASE SEE REVERSE SIDE) CLASS 0 .'$TEWART ,SA8FtINA.L .DR 3F N't;~ : 08.2., SIlXF EYES:-'.1rr:5-.01 E:.NONE ..1IlIIl:,.' R:B .- IllSlJf!O: 03-14ollll EXPIRES 08-21-'11 77lI2t8V1 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for COe}' of Marriage Record ... ::::':::.:::.::..:::':':.:::::::::::'::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::1111:::.::::1:1111:1:,:111"811::::11.1:::1_1:::::::::::::::::::::::::::::::::::::::::,:::::::::::::::::::::::::.:::::::::::::::::::::::::.:::::.:::'::::'::::::::.:.::':::,.:.:.:.:::::::,:.:.,:::::.::: . . . . . . . . n...... ..... .' Search and D Fee $1 Search and [J Certification 0.00 Certified Copy Fee $1 0.00 per copy per copy A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information under the seal of the Health Department, includes the names of occurring on the original record of the marriage. the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and A Certified Transcript may be nem=roofol groom. parentage and certain other detail ~ required such as: passports, veteran's benefits, cou A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estcSEp .. 'j 2008 T0l1['r I i"GRK :::::::~:::::::::::::::::::::::::::::,.:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::I.II:::BIRllml::::IIII::.:IRI::::I:IMI:::III::::::::::::::::::::::::::::::::::::::::::::::::::::::::::,:.:'::::::::::::::::::::::::::::::::::::::::::::::::::::::::.:,::::::::,:::::::::::',::::: PLEASE PRINT OR TYPE Name (First) of Groom Groom's Age or Date of Birth Residence of Groom O~JZ Date of Marriage or Period Covered by Search Place Where License Was Issued (Middle) p, (Last) fJ/lo;1l '/ J' A 1.1,-1\ 6/ I.' /tt7;? Y (County) (State) y; AI' 5'C5 '-_ c..? (p /Zl RV.-V c~/r W?"J'7/3;./ j~ Name of . Bride Wv~~ Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (First) (Middle) (Last) ~tl~ ,..- ~ /f//J / 5 ') (County) ,?)v ./~ L," (State) s ;U ;t/~ .......................................',.......................................................................:............................................................................................................................................................................................................................................................................................................................................................................................................................................................... What is your relationship to person whose record is requested? If self, state "self." For what purpose is information required? il~ C/V~-? /).y' 7;] ]/.:;).'--/ ,',L In what capacity are you acting? ~-C? ~ .Fe C,/"' If attorney: Name and relationship of your client to persons whose marriage record is required. Signat~of ~PPlicant, --r -' (;< q iVr"/ -:YV; (Jr7/'k Address of Applicant /? 6 p-","'" L 0~F).v (Jorf',v; "I\.. I~ //'J, N:; /2 jf.::> DOH-301 (3/93) Date 8 ~ - o'? Please print name and address where record is to be sent. (PLEASE SEE REVERSE SIDE) ....~.~ "..,..-.-'"'......,'-,-..._..-_.,.,,.,..."'"....~..~.--:~ CLASS ID w"""'c~ 11 fYES 'fi:..~ ~~:~ .JSJUEIl. 12-05-05 E~: 88-11.1'8 lM147ll1lO Application to Town/City Clerk for COe>' of Marriage Record D TOWN CLERK Name (First) (Middle) (Last) ~fride $~((fT Bride's Age or Date of /' I Birth q -'-1- S- I Residence (County) ~fride s- tJ e t-1 rJ. lJ /Z Pv If Bride Previously Married, State Name vi <.rk,e. Used at That Time / I () Place Where Marriage Was .F+? 7 (0 Performed (C:.. .) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. PLEASE PRINT OR TYPE Name (First) of Groom Groom's Age or Date of Birth Residence (County) , (Sta~ I ') ~room '-I;);; tzlcke &ne ~ f/l'1lL Date of Marriage or Period Covered by Search Place Where License Was I? 3 7/- Issued Ie co (Middle) 'Ie D !() ~I/- s-L{ (Last) PeritS6/u J1~ Search and Certified Copy D Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an ,estate. !!:~~I ';) /)..? j If self, state "self." tf'tZ.r t5lt e L r:-€C O~r J ~C;J:-~ 0 In what capacity are you acting? (/~u; 6 /hf c/ If attorney: Name and relationship of your client to persons whose marriage record is required. uf) (jo r /. . 00) P~/l A),V /cJ!t:>D'd.. DOH-301 (3/93) Please print name and address where record is to be sent. (PLEASE SEE REVERSE SIDE) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for COe}' of Marriage Record .: .' ..::.... '..: ...::::::.:..:....::.:.:.ps.ms....:eca... lesiAli:lc6r:::':': 'k::.:: ..::.,,::...::::.::..::.::. :. :....::.. '" .. .. .... .., ... ... .., ..... '.. .. ... .. ...... . ... ..... " . . ..: . :::: .:.:.:..:..:.;.;:....::)/.:...;.::;::.:::q:.::). .:::n9 .}.}}:::::::::!!!::::.:::'=::\:"'::" ...:)..:.. .' ....... ...... ...................................... .. ..... '.. . .. . . .. .. ... ..... ... ........ .. .. ... ... .... ..... ..... ....... .... .... .. . .' .... ........ ... ,.... .., ....... .. ........ . ... 0.. ....... . ..... ..... ..... .. ... .. .... ...".... ..... . . . ..,. . . .... ...... . ... ...... .... .... . .. '. ............ .. . . ........ ... ..... ...... ........ ... . : ... . .. . ........... ..... '... .. .. ... ... ...... ..... ...... ..... . .... . Search and [gJ Fee $10.00 Search and D Fee $10.00 Certification Certified Copy per copy per copy A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information under the seal of the Health Department, includes the names of occurring on the original record of the marriage. the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of groom. parentage and certain other detailed information may be required such as: passports, veteran's benefits, court A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate. PLEASE PRINT OR TYPE Name (First) of f) Groom D~TT Groom's Age or Date of 4 /Ill I, ~ ~lJ Birth I Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was Issued (Middle) K. (Last) L.Aff \ N T~~A rf. (Last) gLMJT>uJ 0 (County) pllrc Iff $'5 (State) Nt Name of Bride Bride's Age or Date of2 / I fo / I '1 g 7 Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (First) (Middle) (County) lJT c ~ s.s (State) ]J1 g/B/O& Wflff u-J b U 5 fila S For what purpose is information required? UfDflTJlJ~ fYJotl1h l>OCvHt.J./1S /,V/ g/l.I/)(. ~ NeW U/5T' .AJtH'1t What is your relationship to person whose record is requested? If self, state "self." ShF In what capacity are you acting? If attorney: Name and relationship of your client to persons whose marriage record is required. r 25'1" Please print name and address where record is to be sent. BRtl1 LAff IN 37 TtltUSA ~v'l> VMfltJb~.s F-AlLS I Nt \ 251 '-' DOH-301 (3/93) ,J', .-.. FIG:..c (PLEASE SEE REVERSE SIDE) 9007 n? t, ~:;:"lr):JU /-- NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for COe}' of Marriage Record Search and 0 Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy O Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. .. .......... ............ . . .. ........ ........... .............. . ............. ........................... .... ...... .... ... :::!:::::..:::.::::::::::::!::':..::::::;:::::::.::..:.:':::.,:::::.:.:':::':t~:~~~::.:@@lg5g00!i.E~II.:.I'=!@:J~:Er!1~:11rE.I?:...:::,::;:::::::'.:::.::.i::::::::::,,/::::::,:i:::::::::::::'::,:';::}::'.'::.:::::::i':..:':':":::::::.,,:::'::....... PLEASE PRINT OR TYPE Name (First) of .,~ Groom _J 0 V\ 'i\ Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was--'\~~ v...:',., ?' ./., \1L)c '\)' .? \~ c{. C ;'"t.'- \ ~':J Issued L.: J (Middle) .~~ l.t l (Last) QLl\ \e S ~ ' ,J.~ ,-l ~ (County) l\.. \ c)~C \( (State) 'N.l\. "\ I - \'d.' c:t'/ For what purpose is information required? l /" \ () ",/": c:)~-\- L.c c+',,,-, Cc~ .",' In what capacity are you acting? Address of AP,.I2!!cant.. r;) ~ J '5 (''-6-- 0 b~ r\ u 11 ri' '---. ( n/lbv.d Cc (.t? / '71 (j rei J d-.\- J -:;- DOH-301 (3/93) Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (First) Va \"-.Q '::> S6 (Middle) lc'V\ (Last) (\Jf\~J; /, \- \~ 'ld-- (County) U. \ S~€ (~_ (State) N.~\ > What is your relationship to person whose record is requested? If self, state "self." ~{ ~ If attorney: Name and relationship of your client to persons whose marriage record is required. Date t- /0 -LJ ~ Please print name and address where record is to be sent. VCL ~1/-.s<i..)D~. C>2\-\...,: to.(' S_ \ 'd-. \ --S-~do \0 ,'" . \<-u.." \:0 ' C \.~\-\:vrv..dc~J,.() I ').'-'J \d- 'S I ~ iNi~"'./i~i ell (PLEASE SEE REVERSE SIDE) "1'\8 ~:J "'r- ...~) vI..., " ----~/ Application to Town/City Clerk for COe)' of Marriage Record <~.::!:::::~:1:::::1:':::.:::':1:::1:1:~::::'::::::!:::::!:!:::::::::::l'::::i:i:i:::i::::::~i:::i:i.I:::_:::!I:IIII:11:::IIIIIII:i:illllll:i:l_l:::::::1:1:::::::j:j:::!:!:::::::!:~:~:::::::::!:!:::::::i:::::::'::~:'!:':::::.:.:::::':~:::::i:~:::~~::::!:!:::'~l:"::::::::::::::::::':::!:':1::~::!::'! NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, co.urt proceedings, or settlement of an estate. ....:::::::i:::~::.::::,'~:::::::::~:::::::::::::::::~:::::::::::::::::::::::::::::~:::::::::::::::::::::::::::::::::::::::::::::::::::III:&I:::IIIIIIII::::EIII::::111::::1:111:::111:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::~:::::::::::::::::::::::::::::::::::~:.:~'..'::::::::::::::::::::~::::::'::: PLEASE PRINT OR TYPE Name (First) of \ r . \ Groom \f'\.e.. \~t' Groom's Age or Date of ......, "". Birth ,> do Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was Issued (Middle) (Last) t ~\fW$jf\. 06 { ~~ l \. b (State) .- ,(~ \ O\rl \=OJ\ \~ For what purpose is information required? \JCA~~0(Y -~c..~~ 0~~1l\,~ G In what capacity are you actingt J~(~~ Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was \ \- Performed \..)\J\;, (Middle) (Last) What is your relationship to person whose record is requested? If self, state "self." ~~\-e- If attorney: Name and relationship of your client to persons whose marriage record is required. Signature \f pplicant Address of Applicant \ ~~ ~ Q, Q., ~ \;}",~(;,.~~Q,{5 ~\\S \$'1 \).t;"v..O DOH-301 (3/93) Please print name and address where record is to be sent. H t:\J CJ V cO AU.:i { (PLEASE SEE REVERSE SIDE) Tr>,~ , ~r-:)'J( '..~KST~~ .........Si . . . . . "., ~'"'~:~'~_4''''''~''' .....:'JIJ~""_.... .~~ .. DRIVER LICENS!-, 10: 12~ 480 23ft'''"CLASS J: ,,) '..-. 'f. 11 ! i... ~ : \ ,poUfI\lOH,J(j,rti,F 1 8QUTilUfi''P'" "<iE.\:n~ NY l?li$Q : 06-2h" :~ fYES'~I!l';'-~lII E: NONE Ai. NONE ~" ISSUeo 11-14:07 EXPlffl:S: 06-21-10 7644.'11111 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for Co~ of Marriage Recordu-- . . . . . . . . . . . . . . . . . . . . . . ............................................ ..................................... ...... ::i,i:i:::':::i:::::,:::,:':,,':',::::::::::::::i::\i:!:!:!:::':::::::::::::::::::::::!:::::::::::,:::::\IIII:::II::::g:lllg:I:::gii,=lli::\:igEII:':llil:\\::::::::,\::!:!:!:,:::::::::!:::::::!:::::::::::::,::::::::::::\':::'\'\::::':::::::::::::::::':::::::::,::::::::::\::!:i:::::::::i::j:j::::::::::::::::: Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy D Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Tra~~I;~~~ where proof of parentage and certjli~.~threr,..detailed information may be required such as: ~PQh$), ~~n's benefits, court proceedings, or settlement of an estate. T("Ilil'~, 1"" ....._ ..' . ~'1r\ '::::::::::::::::::::::::\:::::::\:\:::::::::\::::::::::::::::::\::::::::::::::::::::::::::::::::::::\:::::::::::::::::\::::::::::::::\:::::::::::::1:..1:::111111ml::::iIBI::::III::::g,\ell:::III:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::,::':::::::::,:::::':::\:::\':::::::::::,::::':::::::::::: PLEASE PRINT OR TYPE Name (First) (Middle) of ()' Groom K. l CA-\ l1 (CD 'B . Groom's Age or Date of I I 2 r ....., Birth 'I" ".':> <- ~fesidence ~(county) Groom c.:7"v\ ~ s S Date of Marriage or Period Covered C (, by Search' C l:J. {-Z , Place Where f Ucense Was W p... p P I 10(0 t~S Issued (Last) 5\..\ LA L -r 2- (State) o I?CJ 3 ~ t-/-\ Ll S What is your relationship to person whose record is requested? If self, state "self." For what purpose is information required? 10(; u.J Sac tAL 5~Q.L( f~{ T1-f .:tI::- (i.Arp DAtE 0 F AJIt: If.,{ t! :) In what capacity are you acting? 5 t:;l..- F 1';2, ALL ~0ELS 1ft L~ i2() - LuJi//~. F;+L~ S /U L 12 r;; '7 6 I DOH-301 (3/93) (First) (Middle) (Last) S I+U LTZ- Name of Bride MAfC-1 L'- r-JAJ Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name M A,2.1 L Used at That Time Place Where r. · Marriage Was . t- l ~ I It<::. { L L Performed Jt1 A (. 1<6'- y~ (County) y u.. <tc.A+E: s So (State) 10 tU A.J A. TIAfZU€ S~LF If attorney: Name and relationship of your client to persons whose marriage record is required. (J', ~.08 Please print name and address where record is to be sent. (PLEASE SEE REVERSE SIDE) ? t ,~' ::~,,' on if' .. _;: .', I ..,' ' , c;; [ h1"~' ! ~ljri.,,,,.,,{,,,,, ....~ "g!~ "~ -~1 / m':t: ~:'!!' . ;... i'~21- ~,a 0" (fJ . c 't')- ".' ", -~_ ,r~:; ~ .."..>~OI .. ,s" '!l".. .~" .c. "1E w,. '!!'. . '. " ,.~;: ;~~~"~/ . o~ /"''''' ~_:_' t J1 ''''' '. .:';OO~ ,. . "S-' -:;-. ,.' . . f' .... '~m.' ~ ~. ;., '7J ',- >:!F---~ .' ..... , . ;j<:. ,1\l'ftZ.~..'1,r (fl .:' , r ......:',.__-.~;::}t:: ml " ..",.; >!} , NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for Co of Marria e Record Search and Certification D Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy ~ Fee $10.00 ~ percopy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. !\:i::::::;i::::::::;:::::.::::::::!;:;;~::::::!t!::l1i~J:::::[~i\%M&*JMJ.;~11__II.'''];.':''''L.:::'::':,~...i:::::...::.....;:.:\:\I_;:*1~t11*M~:i\::~11i\;t.:::l~:J.;;:;\;;:~~i1;:::\:::::::;:::::::;.:;::::::::::::::.:(,:.: PLEASE PRINT OR TYPE Name (First) of --r Groom -.J O~ e Groom's Age or Date of Birth Residence (County) of L Groom utcn €.$S Date of Marriage or Period Covered b Search Place Where Ucense Was I., Issued Wo.... (Last) DeS:tt"ct\~ 14 - J-O - I ~ y. 5" (State) t--JV Lt-~~-l.2 For what purpose is information required? ~ r Sex:. ,'cd In what capacity are you {3ting? rJ~ t-he rIde of eec-o ref DOH-301 (3/93) Name (First) (Middle) ~fride Lo rra.~ ne A nl"'l Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where st. Marriage Was ,., Performed vv (Last) Dowlr" 5-/1-('147 (County) utc.h.ess (State) 10'/ NjA hurcl\. fa.lI & I\J '/ . What is your relationship to person whose record is requested? If self, state -self,- S e l ..p If attorney: Na."TlE'l and relationship of your client to pcrscr.3 whose marriage record is required. $119/0~ Please print name and address where record is to be senl Ie::- ~ (PLEASE SEE REVERSE SIDE) \"i c:. \J C. \ '\it::. U A.U~; ~:.- 1008 T"" ^ ' ^ ~ r.pK , ~~IJ~ (~~jJ~J fYl a V1l i~ ~ f.//'" ~ s lot Ie 0 f P/o{l/ J /6 r nA ,'rte. "~ Sl y\ ~ ~ I"j IJ'J () I' S ~ ~ r ~H1fA / I '^d trr/fJvU "- 1-< VY\L ~~ N. ~ VI1A ilV\ fJv. Cj I 1/ d tJ tJ \". . ~~.~ jl ~. W~I ~hl'J ~t1{j/2 . '. < CWlAllWAalSI U I V" U ...~ .. MY COMMISSION' DD 443350 ~~... EXPIRES: October 22 2009 ~ OF f~~ Bonded TIvu Budget NoIaIy Servicel NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for Co of Marria e Record Search and D Fee $1 0.00 Search and 0;ee $10.00 Certification Certified Copy per copy per copy A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information under the seal of the Health Department, includes the names of occurring on the original record of the marriage. the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of groom. parentage and certain other detailed information may be required such as: passports, veteran's benefits, court A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate. Ju Z /~I//~.r PLEASE PRINT OR TYPE Name (First) of Groom Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was Issued (Middle) (Last) (Middle) (Last) (County) (State) Name of Bride Bride's Age or Date of Birth Reside e L. .\. . of, . I ell 1\.,.1"=-- f eviously arried, State Name Used at That Time Place Where Marriage Was Performed (County) (State) For what purpose is information required? What is your relationship to person whose record is requested? If self, state "self." In what capacity are you acting? If attorney: Name and relationship of your client to persons whose marriage record is required. Signature (fA..~.)~li~~nt '>?~ /!:lu, Address of Applicant Date Please print name and address where record is to be sent. DOH-301 (3/93) (PLEASE SEE REVERSE SIDE) Ht::L- AUl; i' : 2008 Tr'il ",. . "r:RK 'lfa; 55"1 NAME CLAIM NUMBER X RSHl Fells, Evelyn V 129-24-6964 01 DATE OF flUNG ALLEGED DaB OR AGE PERMISSION TO USE NAME DATE OF REQUEST PE 6/9/1931 Yes 08/20/2008 ED DATE OF DEATH DATE OF ONSET RACE. SEX Enumeration F HU~-~~-~~~O ~~.~~ Asslstlng Office Social Security Administration POUGHKEEPSIE NY SOCIAL SECURITY 191 MAIN STREET POUGHKEEPSIE, NY 12601 DEVELOPMENT NOTES Fax: (845) 452-7347 CONTACT: Marriage Bureau Wappingers Falls, NY PHONE NUMBER: PHONE: (212) 399-5330 Ext: 3063 FAX: REMARKS OR REASON FOR REQUEST (It the request Involves prelaQ earnings or ED, gIve Ihe following Information: (1) Dates of alleged employment and earnings; (2) Central Office records show; (3) amployer's name, address. E.I. Number; (4) Wage earner's address, job, badge number; and secondary evidence submitted.) Social Security Administration MIDTOWN NY SOW SOCIAL SECURITY ADMIN MIDTOWN SDW UNIT 237 WEST 48TH ST NY, NY 10036 T UNIT NO. I ZZZRIC ACTION REQUESTED DEVELOP PER ATTACHED EARNINGS INFORMATION OST AIN COMPLETION OF FORM SSA-7011 X oer AIN PROOF OF Marriage VERIFY BIRTH CERTIFICATE SBIIAS ALERTS Requesting Otflce Bride: Evelyn V. Fells DaB: 06/09/1931 POB: NYC, NY Groom: Elias Fells DOB: 09/27/1909 POB: poughkeepsie, NY DaM: 11/06/1965 in Wappingers Falls, NY SDW claim pending, please expedite, thank you so much for your assistance! Form SSA.662.U3 (3-1983) EF (8-2000) REQUEST FOR ASSISTANCE/CERTIFICATION OF DOCUMENT(S) or RECORDS TOTAL P.Ol ....-- 'I. , f~s" {O { ~lo(21 ft/{4Y1 ~ ~~ '^ J . ......0 ~ ,~ \ q/~1 . ~qS g70Q U'ttl .t(r tv<.- , ~oc/i: Q 100 CrwSO- ~ CeiL! G ~v$i(&fi.- ~ r-- -..9 '::r ~ ~ ~ rJ" ..-" '\P -Z-<0 <L VJ '~ / .~ ::J l)Q -r;~~i:l: "1 0 l_. VA LkS Y1...U \/f/.. L.' ~ 7fPJ M to-\fle.L "<51r'tc# \IJ tTs ~'1. J, '-' V}/1 ~ ~ s.~te~ ~+ )) w{eM$. f' NEWYORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for Co of Marria e Record Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. Search and Certified Copy Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certification may be used as proof that a marriage occurred. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. PLEASE PRINT OR TYPE Name ( First) (Middle) (Last) Name (First) (Middle) (Last) of G Ca. e +-f of S. C, a.. Vv-c: +- t Groom Bride ~ r 0...- Groom's Age 1/ ')..0 h q Bride's Age ~1d-4\'S:- or Date of or Date of Birth Birth Residence (County) (State) Residence (County) (State) of <-^ h. h.e j s. "I of 1) \.A. \c ~~~ N'I Groom Bride Date of Marriage <b\\lo~ If Bride Previously or Period Covered Married, State Name by Search Used at That Time Place Where Wo- , Place Where W~ Pf'IV1.je.,v<;. Ucense Was IY\.~ e1V <;. Marriage Was Issued Performed . . For what purpose is information required? ~vS.O'Y\a. \ fer nvd ~ What is your relationship to person whose record is requested? If self, state "self." S-e- \. f In what caSci~ a~fu acting? If attorney: Name and relationship of your client to persons whose marriage record is required. <6 \d\\UY Please print name and address where record is to be sent. h t:,LJIc \\1 ED ", 08 DOH-301 (3/93) (PLEASE SEE REVERSE SIDE) ,-n"" I r:RK ~NEW ~RK STATE. ~." . '.. .1"; 1(". .~_&. .e~ rn.._-~~.~ ~~~~~...............~.....~_-'".'"".>WJ.<~'~~'~-"",,,.j..;.'~., DRIVER LICENSE 10: 802 174807 CLASS 0 ../ . U. /AAA- rJ' 1;74IC,v.l:t GARRETT 'lAflA,SHANI.:!1;Y/' ,~.'DrIl ..., GE9l:fS~ 12590 _: 05-29<.1'5 ".. .... fiXF EYES 'St,j\{J '5-06 E' ,NONE -,,~.. R B "" " ISSUED 08-01.06 fXPIRfL 05.29-17 . -.. -- NCK77NGR14 Application to Town/City Clerk for COe}' of Marriage Record :::::::::::::::':':.:!:':l:.:.:.:::::::::::!:::::::::::"l,!::'!:::::::::::::::::::::::l~::::::::l:l:l:::::':::::::::::::::::::::::::::::::::::::::':::l:!::IIII:::_:!::I:IIII:I:::III~III::::illll:::lgi'::::::::::::::::::::::::::::::::::::::':::':::::::::::::.:::::::::::::::::::::::::::::.:::::::::::::l:::':::':',':::::.:::":::::::::':':'::'::::::::::.:. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. ::::::,:::::':::::::::'::::::::::::::::.:':::::::::::,,:::'::::::::::::::::::::::'::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::1..1:::11111111::::1161::::111::::1:111:::111:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::':::::::::::::::'::::::::::::::::,::::::::::::::::': PLEASE PRINT OR TYPE Name (First) ~room ~osef Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was-r-. Issued 10 uJN (Middle) 01 - s I s- (State) ~w 'loR k It!!( ?6 l;J {,- P et;... w trt:{i. (County) DUTC ~5S /tp R:rL For what purpose is information required? In what capacity are you acting? Ad r s of plicant $"- (3 6: ~(."'l WOO fJ ttJ2. C.L€- /,J A-f f r YIlt:;- ~ (jl FJtLLj / fL! Y I A'~ D DOH-301 (3/93) ( First) Name of Bride Bride's Age or Date of Birth Residence of Bride D lJTC If Bride Previously Married, State Name Used at That Time Place Where Marriage Was CT: Performed .:>. (Middle) (Last) (5 0$5I 5 f-oOULft (County) €>S (State) N€r.v Yon l\. o~ L<.$ What is your relationship to person whose record is requested? If self, state "self." 5 ELF If attorney: Name and relationship of your client to persons whose marriage record is required. 0'3 - /er - AooS Please print name and address where record is to be sent. (PLEASE SEE REVERSE SIDE) AUf] r [32008 Tnlll,';' , rfERK ~~~ :S~.Ji;,... "'J)Rl'~R LICENSE tD: 273 '.0 350 . CLASS 0 ~~al:;. .:"~ ~~s1'i,,~:'.~ ' · E: 'NONE ~".,... R: 'NONE "" "'" ISSUED 07-25-08 EXPIRES: 07-31-10 LVVJlZl'411 .~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for COe}' of Marriage Record ......... Search and D Fee $1 Search and D Certification 0.00 Certified Copy Fee $1 0.00 per copy per copy A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information under the seal of the Health Department, includes the names of occurring on the original record of the marriage. the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of groom. parentage and certain other detailed information may be required such as: passports, veteran's benefits, court A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate. PLEASE PRINT OR TYPE Name (First) (Middle) (Last) Name ~room A; - 111tl f}J U ~fride Groom's Age Bride's Age ~~ate of I 6 ~~~ate of ( 0 ~ '] Residence (County) (State) Residence (County) ~room 'fu f.J ~fride 'Du-h:k \ Date of Marriage If Bride Previously or Period Covered Married, State ~ame tR' e J- t- b Search Used at That Time I.J /L Place Where Place Where License Was I J, Marriage Was I I' (j Issued VU Performed LN (First) o (State) (Vl For what purposf ~ information required? IO~T What is your relationship to pe~~ whose record is requested? If self, state "self." <:;:'e ( f- In W?!;;P7i~ you acting? If attorney: Name and relationship of your client to persons whose marriage record is required. Date 8 I 2- / () y I 2l- J'VL( 1-/1 II 11 ) },\, ~ l l) IUL! ~ / '2- \2 l( Please print name and address where record is to be sent. DOH-301 (3/93) (PLEASE SEE REVERSE SIDE) ~ CLAS$ '0 , .....,-'^"~.....__..'...4~.;.;;........_ F:" _ .~' ,~ <. t". "".,~'ii"j;.i' . ~ 'i6\j; MS .~.. '-~, , {'JiIONE ~ "'''11 'ifI' R NONE ~ ~" " . .#0 , ,,jSSI'IEO: 01-02-07 EXP~' 94-t&-13 _ " NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for COe}' of Marriage Record Search and D Fee $1 0.00 Search and D Certification Certified Copy Fee $1 0.00 per copy per copy A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information under the seal of the Health Department, includes the names of occurring on the original record of the marriage. the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of groom. parentage and certain other detailed information may be required such as: passports, veteran's benefits, court A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate. (State) N{ .:J 00 3 rO;2 .2 003 t/J6i:/) /} ;/eTs, ~~ / u .n I If self, state "self." / (osf fft:;f/;-fre t<::<?('"dd /??eed Acw (')I?~ PLEASE PRINT OR TYPE Name (First) (Middle) ~room (flAAJ0 tf {}O N Groom's Age or Date of 8 - / Q Birth 7 Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was ,;?;, tv J./ Issued (Last) iE~ /9S C; (County) DU7{f/ In what capacity are you acting? Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (First) (Middle) (Last) k'//'i /962 SU;1/ itEr;- ij - 1 .- (County) (State) o U7 ( If iJr JW 1 5 2008 If attorney: Name and relationship of your client to persons whose marriage record is required. Address of plicant J 1 HIIJA pR. aJt2;jJ;'lIfl/S ~~g) fJY 12S'jO DOH-301 (3/93) Dare ~ 7 - lj - 0 0" Please print name and address where record is to be sent. C f1,ANqIlOOAJ L EE 3~ H lA/A OR tVa ;)1 C'/ s k//s) IV (..2-5JO (PLEASE SEE REVERSE SIDE) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for Coe,y of Marriage Record .. ........ .......... ........................ ....................... ........................ ....................... ..... ........................ ..... :.., :.:......::::.::::::\::}}::...:::::.; :::.'RE' ::E:':' ....::.::e. "E'" "0':':"::'0": "':e' :::::s': . :0':':':::&: S' ...1.9......E....0. . :fc............:::::...:.::k..:.::'Q.:.:....:.. :::-:".:.,....::.::.:::::::::::::::::::::::::::::::::..:..:.:..'. '. ,'.::..:" "::::.,:::::::. '.': ............. ...... ..................... ... .. .... .. . . ~ _.................................... .... ': ~., . .{::.:..::.~:.:...: .::.:.:~~::.:{.:.:.<;: . .::. '" ',' :::;:: :..; ..::::'::.\:,,' :.:: .;~:::; '. ." ,,;::.::.;:;..: . "." :' , ~" .:....:.:. ,:~ .})(rt~.r:r:Jt:.. ',,: ,', . .~::: ':'::":'::~:ri(' ::. '" '. ;' ..;' . Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy R Fee $10.00 ~ per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. :...:::::::::::.::.:'::::::j:j:!:::::::::j::jjj:::j:::::::::::::::::::j::::::::j:::::::::::jjj::j":j:::j:::j:j:j:::j::j:::::::::::::::::::'::jj::!j~S:.E:::_Blli1::::EIII::j:181::::I'=:llljjjlll:::j:::::::::::::::::::::j:::j::::::::,::::::::::::::::jjjj:::::::::j::::::::j::jj::::::::jj:j:::::j:::j:::::!:::::::j:::::jj::::::,::::::::::::::::j PLEASE PRINT OR TYPE Name (First) of Groom Groom's Age or Date of Birth Residence of Groom V -/.j /~ Date of Marriage or Period Covered by Search Place Where License Was ~ J Issued ,/ ~ /7 /) tl /' Jl/' -k-( (Middle) (Last) .:-' ~.' 7 ~~/y d- (County) (State) /)/f;' For what purpose is information required? . S::~.)r /' P9 L. S~C::-.,,~A7 / 7y / In what capacity are you acting? (First) (Middle) (Last) .L...< / E" /\/ Name of /-J Bride L-/JIJ.L).J-k. Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where L)L.7 ':ra& .>2 r /J"1 Marriage Was ",AJ"""- \3 7- G Performed 0.1'9 /J/.!)/./II ~'"' -3 ~,3/.y~' (County) (State) What is your relationship to person whose record is requested? If self, state IIse~ ~ F If attorney: Name and relationship of your client to persons whose marriage record is required. Signature of Applicant ~ / ,f} / "r; Address of Applicant . / '7 /J/9~/""f? /) ;qC-f7 ~n~~d~ r-~ , , '/7.- / DOH-301 (3/93) 7 Date <5 - <.)~ Please print name and ~~C EirVEoDis to be sent. JUN 2 5 2008 TOWN CLERK (PLEASE SEE REVERSE SIDE) ~ ......~..'^ "" - : -\ 1'~\,"r" 1~ \"r .~~ ~r Of.Mdter \JeniCIe6 10:765343-621 . Application to Tbwn/City Clerk for Co of M' rria e Record j:':j::j::':'i:::i..:::::::::':j:j,::j...::::::::,,::,.:::::.:.:,:::::::::,:::':':':':::':::::::::::::::.:.:':::::::::::::::::::.:':'.il:::II:,r::'.::lllm:g:::gll"111::::[11111:::1111:\:\:\:\:\:::::::::::::::::: NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Search and Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy Fee $10.00 per copy A Certified Transcript includes alllof the items of information occurring on the original record of the marriage. A Certified Transcript may be ne~ded where proof of parentage and cert. ain oth.. er detailejd information may be required such as: passports, veter~n's benefits, court proceedings, or seffiement at an e*ate. ::",::::..:,':':::::::::::::::::::::::::::::::::::::::.::::::.:':'::::::::::::::::::,::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::;_1:::11111111:::'1111::::111::::1,:111:::511:::::::::::::::::: PLEASE PRINT OR TYPE Name (First) of 0 j . Groom CQV, l) Groom's Age or Date of Birth Residence (County) (S~ ~room ~~~~ \ W J \. Date of Marriage '\. __~ or Period Covered ~l)q, \..> ~\- d- ~ \ ~ ~ "\ by Search ~ Place Where c> \' Ucense Was \ ~ D~ \....9.:)~~~ - '\'1 ~ , Issued (Middle) e.... L4.\\~\01\ (' ~.st) _ '-..)l '\~ S,. 'L ~(. (Last) 1::>\.)\\ c\. ~ Name (First) of ~~-r-. Bride Bride's Age or Date of Birth Residence (County) '- ~tate) ~fride ~~'t~ "1- \ ).....J;j, If Bride Previously Married, State Name - Used at That Time Place Where . ~ '" \ MarriageWas $\\\~\ V 0"" W~?V. \\ S. Performed . .::)):::i:::;;,,:jij::i:::::::::,:i:'::j::::::::j::::::::;::jj:::::::::j:::::::j:::::::j::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::':::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::ii:::::::::::::::::::::::: For what purpose is information required? "Jv.u~~~\\'l)~<')~ J In what capacity are you acting? Signature of Applicant (),_ ._ ~ ~~ ~. '-::J{~ Address of Applicant " ~C) '"?~c:f:t) ~~. "-uc,.,~ ~ . ~\s.' $..:) ~ - \~S""10 DOH-301 (3/93) What is your relationship to personiwhose record is requested? If self, state "self."~~ ' If attorney: Name and relationship of your client to persons whose marriage record is requiredj be sent. (PLEASE SEE REVERSE SIDE) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to 110wn/City Clerk for Co of M' rria e Record HH!!!'!,.:::::::!:!!!':::::::::::::!..!:::::::':!:i:.!::!:':!:!:'::!!:!I:i::::::::l:::::::::l:::l:l::::iiii:::::liil::i::i::i:li::l::::::IIBI:!III:::1u:lllu'lllllIllli:::IIIII:::llll:::::!i:::il:l:::::::1:1:::: Search and 0 Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. Search and Certified Copy Fee $10.00 per copy A Certified Transcript includes all pf the items of information occurring on the original record of t~e marriage. A Certification may be used as proof that a marriage occurred. A Certified Transcript may be nee~ed where proof of parentage and certain other detaile~ information may be required such as: passports, veter,*n's benefits, court proceedings, or settlement of an estate. ..... . . . . . . . . .. ............ ;:.. . :"::::" :'. i' .:.::': :;:...::. :.:.}!::i:. ::::':':'ltlI\Se:':.mMPIEmeF'RQRM', ANDi=:REMm."eiil;::::';:):X(:::::./'.::::.':.::..;.::(::::.:::::.:. :.:....:.:::(:.: ..../......::::::.:. .......... . ::: :'..... .::r: ",::. ::}::':: .:: :{:: ::':':/( Y;:; : .;....: .::;....... ;.: :',.:: :::';.... ..::~:::. ,': :',:. :::.:::', :../......:. ,',. ::.. :'.. ":. .::. :':=:.,.. :': }:.::..,..: t: ..;'..:. :'~....:.: ::::::.: ;.:.::: :': :..:}:::..: ,.:::.;.; ;.::::~:~::':/'::::. ~:::::t:'::::.:fr~:: ::::~::::.f:' "::" :.. .:. .: ': ::: :::':::.: ,'. ....... Name ~fride --H Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (Last) we\~On PLEASE PRINT OR TYPE Name (First) (Middle) of Groom Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was Issued (Last) J.. ~ y~ S _ (State) (State) L N. . What is your relationship to person ose record is requested? If self, state "self." '. S-e IS If attorney: Name and relationship ofiyour client to persons whose marriage record is required. RECE\VEO II ~h, , 9 ..ft... ' Please print name and address wher record is to be sent. DOH-301 (3/93) TOWN CLER~LEASE SEE REVERSE SIDE) 10: 81'6089 1'88 i CLASS D I I 73283741 ) ~~ Application to lown/City Clerk for Co of arria e Record ......!::I:I:.IIII.:..::::I.IIII:I.:.:IIIIIII1:::(11111,:::gfll::::::::::::.::::::.:. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section ............................ .......................... ....................... ..................... ................. ............................. ............................. ............................. ............................. ............................. ............................. ............................. ............................. ............................. .............. .. ................. ................................. . . . . . . . . . . . . . . . . . . Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. ................. ................. ................. ................. . .... ...................... ................... .................. .................. ................. .................. ..... :::::::::::::::::::::i::::::::::i:::::::.:::..:IBIII:::18IJilmll:::EIBM::.:III:::.siIMI:::lil::::::::::i:i::::: .. .......... ......... . . . . . . . . - . . . . . . . . . . . . . . . . .......................... PLEASE PRINT OR TYPE Name (First) of ...,.... t. . Groom V \A~ In Groom's Age or Date of 3 f Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was Issued (Middle) M (Last) Le-h't ;' u... (County) 'l) v-.h:J~ ~ ~ &/30/01 CK ktJ(~ IN~ (State) fJ For what purpose is information required? L-05~ ofT'.0 In what capacity are you acting? r-71' Fee $10.00 ltJ per copy A Certified Transcript includes al~ of the items of information occurring on the original record of ~he marriage. Search and Certified Copy A Certified Transcript may be ne~ded where proof of parentage and certain other detaili. d information may be required such as: passports, vete an's benefits, court proceedings, or settlement of an e. tate. Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (First) ~b (p ( 1517 81 (Last) ,orerv,O-I'\ L eti Z--;'~ (County) 1>lAt0~ ~~ (State) tJi B \ ~ ff Fa> (.~ tiN i What is your relationship t~ ~rson If self, state "self." !] e I t If attorney: Name and relationship of your client to persons whose marriage record is required. Sig/~ of APP~J;/ ;0 Address 0 Applicant , ::<, C A Ipl'~ ])(f,v'c.. VV~ppl'IN1C~ fC{II~/ tJ Y 12~1 0 DOH-301 (3/93) Date I (p (0 Please print name and address wh ,re record is to be sent. (PLEASE SEE REVERSE SIDE) fD: '983 396 096 CLASS D .-'=.e~~' :".S;;'~U;-UlBt . SElF EYES ilLm 's..os E: 'NONE 'liiiiW' R.:B -, ISSUED: 07.26-07 EXPIRES 06-15-12 ~Jt.tt'+ 7827773fJ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Search and r Certification Fee $10.00 ;.. - per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was Issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy ! ~ Fee $10.00 i a per copy A Certified Transcrrpt Includes all o~ the Items of Information occurring on the original record of th~ marriage. A Certified Transcript may be need$d where proof of parentage and certain other detailed i~formation may be required such as: passports, veteranls benefits, court proceedings, or settlement of an estale. PLEASE PRINT OR TYPE Name (First) of ./ Groom .J (' f-fret.' Groom's Age or Date of t ( I if I Lt I Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was Issued (Middle) rn (Last) Fe I () fY''''' {'\ (County) j)u:tc he~ (State) NY s-I/f{o2 Fa.t I s IDw r\ Clr> rk.s Df.f'\(.,e. For what purpose is Information required? .d:ha~l~0-hen~fIC.~~ V(JvlDlAS II ( (E'S In what capacity are you acting? ("'"'-e If _.sJ._ ._____________.____. Name of Bnde Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (First) (Middle) E II f' ("\ Wr",d 3/101SS: RE ~I' (County) Du.+( hes~ What IS your relationship to person wh If self, state "self." Self If attorney: Name and relationship of yqur client to persons whose marriage record is required. ' ---------------.i ------------- Address of Ap iD t1 tL f)~J V fa 'j , ~/'{1:Jf/1)O J<:t1t/ n, c. I J r90 DOH-301 (3/93) ~w..O(!::-.f:o frca '{fI (!. q+h cJ~ 6 f JI.-l (lP/ )...~~. ~~~- -~~ - N"ln '::J M I, ~ -- = Please prrnt name and address where r cord is to be sent. IN, VI d'j E:. St? f tv. V\ to Ado... Dnvc V'I~ ~ I(s I N.if lJ-rC{u (PLEASE SEE REVERSE SIDE) N E1.fSSA LANDEs ~'_ - . .-,; otary PUbHc, State or New v_ No.01lA..681797 .QuaHfleti in Nassau ColI \ ___ Certifi~t~ Fil$d in Naw YM ~ ~lOn Expires Aug. 31, 26.LO ID: a29 592419 CLASS D L )i6"/~ i j,,-At1~/ , 'fI' .,WEt>{py~~ , '100ft> '. .c, \0':'. ~~~,:ns 1tt,.\H90 $EX:, F EYES Sit. W: 5'07 E IlIONE 'ft! R: El ISSUED: 10-18-07 EXPIRES 03-10-11 554a1701 10 Ada Drive Wappingers Falls, NY 12590 June 9, 2008 Town Clerk, Wappingers Falls 20 Middlebush Road Wappingers Falls, NY 12590 Dear Sir or Madam: Please issue four certified transcripts of my marriage license. Enclosed is the notarized Application, a copy of my photo ID and my check for $40 payable to the Town Clerk. . Please call if you have any questions. My cell phone number is Y 14-5 89-0696. Thank you. Ve~y truly ygours, / I i A J rt11l~ ~tf(i~ Wendy E~afran NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for COe>' of Marriage Record ................. ............ ........... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......................... .. ................. ........... ............ . ............................ .. ..................... ......................... ...:.::.::............. . L...::PMPi.;.,s BE.eOBD.\Ji.)esi.E.lQ~~clf.ne), ....... .................. ................... .................. . . . ... . . . . . . . . . . . . . . . . . . ................... ................... .. -...................... . ................... ................. ....... ... .. . . . . . . . . . . - . . . . .. . ........ . .............................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .............................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...................... . . . . . . . . . . . . . . . . ................................................. .................. .. ...................................... .................. .. ............................. Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. Search and Certified Copy D Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certification may be used as proof that a marriage occurred. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. ... .............. ........... ... .. .. .............. ................... .................. ................... . .. . .. . .. ... ..... ............................................................................................................................................... ..:lqlll:::y.II!+g::::I"~:::~gg::::I:IMg:::lql:::::::::m:: .. ..:.:........ ........ ............. ..... ..... ..................... ..................................... .................................... . ..................................... .................................. . .. ....................... . PLEASE PRINT OR TYPE Name (First) of. h tIC Groom - ) Groom's Age /' '1 c or Date of 5 (/ Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was Issued (Middle) LAJ (Last) Name (First) (Middle) ~').j \ \c~-~\2 - ~fride ~ ((jre/l/L~( \. Bride's Age I j or Date of T Birth Residence (County) ~fride 1) 4~ c ~~ ~ S If Bride Previously Married, State Name Used at That Time Place Where O. I (t" fu \ \S J,~r Marriage Was l- ~ . J Performed (Last) l(>(=)\( ~ ~ (County) 'R".\D \r-ec;..:') Se~ ~ (9c~7- (State) ~ (State) >< {{~l-~ S '"C"fl-ftvoly,0' ~ For what purpose is information required? SCtC ~ CO \ C,.x2A'J"C e~ ----1..~ ~ \~ \ ,,,,- -~"- S In what capa~.ity ,are you acting? ~~ l~ ~\ n whose record is requested? \ \. If attorney: Name and relationship of your client to persons whose marriage record is required. Y' ~ nd_addi=rECEivED be sent. (PLEASE SEE REVERSE SIDE) JUN 0 5 2008 TOWN CLERK ~=~~~~~. DRI\lER LICENSE to: 45. 126 730 CLASS OM USfCKI.FiJaf:lENC~ 1 iJAPL.E STx ' _......l"'nIt.I. .. . N'i~0I'.... ~~_..-. ;~--,- .: 10.0~ t: $EX: F EYES '" +1'[:.'IioOO f. NONE RtlONE ISSUED 01.08-08 EXPIRES 10-03-11 81_810 ---~~.."...~_...,..,...-.-_.-------"'-"~""'~=' ,;~!,J'j -I LJ}:'::~~! OO::-CA -F?Cy,.~-r-!]ll~ ~L[~I,' (e~5 :'fC'i=,i~; '1 ~'7[' ....C!: 1'~1':TY3::1D42 .~ Nt::W YORK 31A TE DEPARTMENT OF HEALTH Vilal Records Seeton ... n -1~~Jt~t._ Application to Town/City Clerk fO~I1~oe.v of Marriage Record ;.. .". ,"'."".,'.... '<>,'}">" , '. -""f'yt-'g9fo,'r~[C5-i%11a-E;'f2~f$\~~~m:;~ft,r'::;r':.:'\'?'-?-':'O\O,..!:},,?~;,:),~~I Ig~'~~'?__~""--"-:-'l-~;,~i:-~~:d~~r:-~~"~~'-:.:;~,~~;o"'"l I ,... C(:;"JllCi:t'".1i1 dn olcJo.tract f, f.'il ;,:~. ,',,"":..1::\,:'" rt::::;~:, d I,'",i,if.d ! fi"..erllfied Tmr,:;;,?':pt jGc.h..des .ali .01 l~1 ,nfonna"," I I Ui!..1.e.r me sea.l O.f .lh;, HeaHr, C)Z;).:-].r~n:,:..:;,..t.. '_''1:-:.!u:~je:~." H"i('.~.;i,...,m~.;:;5 ~,f ; OCCJrnng on ih8 o,-lgtnal rect)rfl nf !he. rr,3I"riage. ~h:~~.~~t;'Q~t~I_;J,p'~I~t1e~1 u"~~:r r~~,id:~:~~ ~:~~~:~: t~G:~ ,:r-:~~}iG~~1~: ' I . W'-:J:' ,'_":,'.UeO ,;"~~ ~'"t'1d as da:6 ar,:J r.lld,,;'~ 0: 1.;.1.L L f "_' ;~:-: ...,117 -:;;j \: ,,- ,:f~!lifh~L1 TrE.:'~c~~pi: !ndV tJS nee-JIt(S wt19r-;: prcnf 01' I groom. parBn18g~ and (€;-rtaT othw oetailed information nay be L t, C :::::' h, ,," d """,,, , "'''9:':':: ~i~~G~~~~~:',~,;,~~~:;~ ~~:~,~::"~.'ts, '0"" . I n':i~l'!.f7'.....t .~.o....... .....l{7:")T~JTji"t~}r~g~;~f"i:~ij'f'FQati.(A~~.~~MtfJ~~~T;'.\\":;~')TI32E2"'....r_~:~,;~;~~~: PLEASEPRIN10f11YPE _ ~,.m' ~"'l + '~iO: ,~-~-"---T~'mo CL IF,""j L I Mtal B !~:'~J Ie c I ~~~~~~9'~0~i~-/~L~~~~;~t][L~L&~ ~PA2~S l ReSldcnl~e ~--;('unt'i) --'--;;-Statc} -...--- Resl':<t;:,nCf- . (c1ounty' ,srate~' ~>o~",,_J)~-IT:~I1(g,".. .. N~:..L-( ~'~ Du 1-e/w.J.~ A J I I Date of Marriage :J.. if Bnde Prevlouslv 1 ~,~;~;~="ro!Jl?:Jrl1Y? ~ .~--~~:~!~l~~~k I (t 5 jvv;"-A]:-~~ ----j ;;: ~~__~_J1lAe~~ .A!0~~_-"_J~;~*~:, ST p <:~ ~j~Nt~;g;;;G~'i~..~~ , " ,. '..0 ~ r::{)r wt.at P\J;'l(Y:;P r= rtor'r'lai:w ~;;qUi;.::-1:-'" -- - o_'--'---'-'-TNf:rt-;;.-~;~ -;-e'l;~';:' t;' pe15'1r1 whose (~'::md-;;;'~ic~7i ! IlY_~~~_L./"Jdlli!eA!lc;.L_~'~"~~"s~------- I I - ------. -.-- ~~~EC.Enl 0-.-----------,---------0.------ itr 1\'1:.:;: .;a;:Ja""ZI!\.' ale; vc:::~;g.?----.-----..----- I' :::t1;;r.E~"- N;;t~e -::~'1d ~~l~,t,(ll1'lt'~J.;;f yewl 'ell"',,', j,) persons i JUN 0 5 2008 wnw, 'narnagt.'J rt::cord !" requIred. I : - -- - -- --- --.- ----~-:-~._.---. ----------.----.1 I . ,...------..---- --..,---- -- ... - ...---T-OWN 01-.1:: ---- - ..-----.~-------.._--. I r--....----F-~~...." ...."!"P'..,....,......,...__ ...,.,.,...., '" ""'"~" ."" ..~,..-., ,.>:.)~'!~~'L~~~'~~~~:~~_~~',;~:::~::":.:.!"'1 t ..;;';:";";:;;;" ;'.:',<:,;,;;;:i:;",.>.",:,:./i<' ...::'0 ;,'c.-.,;.....;:;' ';:';;.,.'/','. "'c, . .,'-...' ." '.. . ... ,"', . . . ..,.,....,-.', ',." ,.'.," . ).../:<1 ","',;.' :. , "":~::'22;./,(-:j:;~<:;,;.::LlL:~:':::,~."._~~ ~~ll.:::::;{jL:1~i(~f:"h<~~:;:"> .. .. . [S'90.' ~~~7~!Ir}" ~:'~01Z!D~ ~ I Aa~';?r 1";''''fi> T 20 /. P,.dS. .',,,, c n~''''''d " '" b..ocl i I. MAt~/S~)J ~1~~L/-D~_._,__...J. DOH-301 (3/93) IPL.EASE SEE REVERSE SiDE) June 2, 2008 To: Whom it May Concern From: Keith J. Haviland I am writing to request an official certified transcript of the marriage between Christine Barnes and Keith Haviland obtained in the Town of Wappinger in 1996. Enclosed is an official application as well as a $10 check as payment for said document. If you have any questions you may call 315-269-5112. Please forward the document to the address listed on the application as soon as possible. Thank you for your consideration W ~(fW ~ JINENE CLARK Notary Public, State of New York No. 01 CL6025569 Qualified in Cl1enango County My Commission Expires June 01, 20.!l. ~ ~ -1- '''''~>;~ . ~-.l'.:tg -rn%:JO$'lOJ <:-".Y},' )$~""_,,:,, ~ c 1\ ~ :a.CO i), . rn (/) -. %. to> t q 1],0"'0(,) "\t;J.o .... rn % O"(')m ~ 'b;J;l!l? ';tc.n ~ ~1lJ~ ~ ~ ;. :r: :::1 ~ :-:I % ' t ~ OZ) .. ,.-... '< 1P f! t" .~ -:;. 0 (\ \ ~ E: Q -- l N , ;::: [ ~ ''\) Ls: D --r--:, R ~ ~ v ..",-- ~ ..,-.. ~ ~ ~fi~ ~ ~.... ~ s- ~ ~ ~~ 4[> ~ ~ \ V' r __I ~~~ .:::::: .-....." ~ \A '2: LS;.' --- N ~ \J ~ \ ~- r Application to Town/City Clerk for COe>' of Marriage Record ::;.:;::;.;:::.::::::1111.:::11:.::1:1111:1::::111'=111::::'1111:.:1_1:.:1:1:1...:.:<.:.::.::.:.:.:::.:.:.:.:.:.:::..:.j.:.:::::{\:)::)):i:):::::: NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section .................. .... .............. ............... . Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy (~"") Fee $10.00 ~ )( .~ per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. . . .. .. ::::::::;::::::IIII!F.e.BIl~!ii:::F~PM :~ni.Q .B.M!:lj::~.E. PLEASE PRINT OR TYPE Name (First) of Groom Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was \ I Vl "^\ N).e (s '0), \(\ Iss~d ~y 'V~. ~ (Middle) \ . (Last) 01 \ ').~ l6 J- (County) ~.\\ .................. .................. . . . . . . . . . . . . . . . . . . .................. .................. .................. ....................... ....................... ....................... ...................... ................... . . . . . . . . . . . . . . . .................... .................... .................... .................... .................... .................... .................... .................... .................... ................. ................. ..................... . . . . . . . . . . . . . . . . . . . . . ..................... .................... .................. ...... .. Name (First) (Middle) (Last) of Bride Bride's Age or Date of Birth Residence (State) of Bride ~ e...<3>S If Bride Previously Married, State Name {\ lCL. Used at That Time \ Place Where r . Marriage Was\u'\()('\ 0+ tG..SJ- n SV\ l. \ \ , Performed For what purpose is information required? tMG. {\~ \'()Lf\,\!L ~ In what capacity are you acting? )A 6 0euruU-.Jll S\ . ~iliQQ\'N1 (iJ ~0.1\~ I ~\\ \ j.11CtD DOH-301 (3/93) What is your relationship to person whose record is requested? If self, state "self." ~ \ ~ If attorney: Name and relationship of your client to persons whose marriage record is required. lo' O~ Please print name and aadress where record is to be sent. RECEIVED JUN 0 If 200F (PLEASE SEE REVERSE SIDE) TOWN CLERk 1,$ ;8T . , ~tA'':l25.h .;t1"'""'~ ;" , . EYEs: ... 1\T; 'Si07- E: .NONE ~'._+ fl: !:l "It.: ," 'ISSl./E1}: l)5..24-06 EXPIRES' 01-11-13 I4M0671 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for COe}' of Marriage Record ...... .......... ................. ........... ................. .......................................................... .......................,................................................. ............................. .................................... ..... ........... ................. ................................. '.i:i::.::::.::.i.IIII:::II::.B,IIII:I.:;IIIIII::i(I_9I:::I.!:.:!:::,::,::: .... Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. ................. ................. ;.;.;.;.;.:-:.;.;.;.;.:-::::;-:.;.;.;.;:::::;:;.:-:::.::::;::::::::-::::;:;:::::;:::::;:::::: ...... Search and Certified Copy O Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. ........... ....... .................. ..................... ... .................. ....::i.iii::'i::::.:.,:.IIIII:SIIRIBg:::iEIII.:..III,:::lill!I:::sII.:i:iiii:i!:::i:!!':i.!:i:::'i PLEASE PRINT OR TYPE Name ~(First) of/ Groom Groom's Age ') or Date of ~ Birth 4J Residence ~(county) of !~I /.vc...;;.....r' Groom ~ r~ Date of Marriage or Period CoveredL (~ by Search 0 L Place Where License Was '/ /'./; /~) Issued / C-<l-{, (Middle) F I 19Y8 For what purpose is information re~uired? 01 tC/Ce. / In what capacity a7 t!1! acting? ~~/T' ddress Of.A~I~~t 4,:S ~~0 r )1:EZ,t) t0~~ "u. i 'U~ /~C() DOH-301 (3/93) Name of L Bride Bride's Age 4 or Date of IQ /0 17 Birth { Residence /c- (youn ) ~fride IJ-I' '/1c?SS If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed If attorney: Name and relationship of your client to persons whose marriage record is required. Please pri t name and address where record is to be sent. RECEIVED (PLEASE SEE REVERSE SI'it)WN CLERK ..... .. .. .................... ................... ... ....... ....... ..... ........ .... . . . . . . . . . . . . . . . . . ................. ................. ..... l:l:::::l:::.:::::::.IMII:::.:l..I:IIIB:I:l:III~III:l::llgsl,.::lni):..:::::.,l Application to Town/City Clerk for COe}' of Marriage Record NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section ....................... ..................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . .... . .......... . . . . . . . . . . . . . . . . . . . . . ..................... . . . . . . . . . . . . . . . . . . .......................... . .......................... ...... ........................... Search and Certification Search and Certified Copy ~ Fee $10.00 LLJ per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. D Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certification may be used as proof that a marriage occurred. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. ........................ ........................ ........................ ......................................... ....................................... . ................... .. . . .. ... . . ...... . ..... :..:,.,::::.:.....:.::::,:::::,::,::::\I:gll;:::_11511:..:IIII:.::III::::I:lg~I:::l7il..:,::::!:::::':::::::: ..... .......... .. .. . ......... ...... .... .................. ...................... . ....................... . . . . . . . . . . . . . . . . . . . . . . . .................. .. .......... ....................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............................... ............................. PLEASE PRINT OR TYPE Name (First) ~room 'D-S ~F Groom's Age . . or Date of 5/10 J d Birth ., Residence (County) of Groom Date of Marriage or Period Covered .;) by Search Place Where License Was Issued (Middle) (Last) Name (First) (Middle) of Bride ~ Bride's Age or Date of Birth Residence (County) of ~ + Bride .).J I.t\ '- ~ S S. If Bride Previously Married, State Name Used at That Time Place Where Marriage Was to r ') I ^ Performed \D C Y I ~ (Last) r- IY L (State) /'1 \ (State) AI - ) For what purpose is information required? ~I:S' PC\S~f~t-t What is your relationship to person whose record is requested? If self, state "self." In what capacity are you acting? If attorney: Name and relationship of your client to persons whose marriage record is required. ddress where record is to be sent. DOH-301 (3/93) (PLEASE SEE REVERSE SIDE) ,"1i,.::r:r:t' ~n I/ , . '\dl'-<'i .""'t 'J!i'!C:tli..:'xi, ! 1, .LJ .', I 'Y;A:~~' !~.~~."",.",." " . eomm....""'" 01_ Vellicles . : ID:1.89686 2t76 .. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for Coer of Marriage Record .................................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... ........................................... ......... -........................................... ................................................... . Search and Certification ... .. :':':::::':'::lllli::II::::I:IIII.I::.IIIIIII:::'(IIII;:ltl1:,!'::!:!: .,"",,:::.,::: ,.,.. "" D Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a mamage occurred. .................. .................. .................. .... .... ............ Search and Certified Copy I\7l Fee $10.00 nJ per copy A Certified Transcript includes all of the items of information occumng on the original record of the marnage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. ............................ ............................ ............................ ..... ". .. .... .... '. .. ..... .... .. :.;.:.:':':':.:.;.:.;.....:.'j:':=::tiir:..".;.:.....:.e.....'..:':.:.......:ri:.'.:.:...:.......:f{....ji.S'.....:.:.:e:':....':.8.'."...:....':"'.':':.:.....:.lf.'.":':.:.......:':S".....:...":....f........:.:..'........'...e"."...:.:.:.:,:,:.:.:.:.:,:.:.:.:.:,:.: :!:tt:J~:~II.:.:.::!:f~R.e41:ti.!!::dll::;M::::I~,I::::B:::Mfy!!ili::/:!!!:!!!!!!!!i!!i!i!/i ..... . .... ...... . . . . . . . . . . . . . . . . . . . . . . . ...................... . . . . . . . . . . . . . . . . . . . . ................. ...... PLEASE PRINT OR TYPE Name (First) of ~ ",., Groom -f. j(;./ L. Groom's Age or Date of Birth Residence of Groom :.;.~, Date of Marriage or Period Covered by Search Place Where License Was Issued (Middle) (Last) s e 't4::r"f/ 5' 3 - ,L-<;l (County) (State) ~1. ' For what purpose is information required? In what capacity are you acting? Signature of Applicant t:"-..~ P ('.4- DOH-301 (3/93) Name of Bride / '.-1/ I Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed tv /t"1' fJ. (First) (Middle) (Last) 5-:' C; I" S~'7 (County) (State) /{,,-( What is your relationship to person whose record is requested? If self, state "self." If attorney: Name and relationship of your client to persons whose marriage record is required. -- - .J.. .- c;, r Please print name and address where record is to be sent. RECE\VED MAY 2 9 2008 TOWN CLERK (PLEASE SEE REVERSE SIDE) "" .. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for COe>' of Marriage Record ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ......................... ... ..................... ... .. ......................... . ......................... .......................... ...... . ..................... . . . . . . . . . . . . . . . . . . . . ..................... ................... . ..................... . . .. . . . . . . . . . . . . . ..................... ..................... ....................................... ........................ ..... .................. ................... . ::"ilill::::QI.:::I:lillm:!III.III::::tltlll:::lfI)::::::::::::::::::::.. .... Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. ........ .. ................... ................... .. ................... ................... ................... ................... .................. .. ................... .................. . . . . . . . . . . . . . . . . . ......................... ......................... .............................. ;.;.:.:.;.:.;.:.;.;.;.:.;.;.;.;.;.;.;.:.;.;.;.;.;.;.:.;.;.:.;.; Search and Certified Copy D Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. ................................ ............................... ................................ ................................ ................................ ................................ ................................ ....................... ........................ ....................... ........................ . . . . . . . . . . . . . . . . . . . . . . . ........................ ..................... ,'. p:uilli::I.~~.II::::f=IIM::::III::::I:.III:::I'IR:::::...:.:.:.:.:::::::::::::::::::::::::::::::::::::::::'.:::\::::::::::::::::::::::::::::::;;:;::: PLEASE PRINT OR TYPE Name (First) of .-J Groom ci (hu(c~ Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was 1 tut1..t''fI'(l~e'S Issued r I (Middle) (Last) e,,(\d k A \ \<AI, 4!q),{ (County) i)J\-r he.s,s (State) rvy Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was s+ M a. f '-~ I ,~ Performed (First) (Middle) (Last) 6clLLuif)' u%€(' I \ 2-d II ~ (County) DL! i-c.. 'r--e ~ ~ (State) Ny \ "\ +r ,S,i--. ~ l I J For what purpose is information required? YcJ ( cpC1. f:::.S pur \- In what capacity are you acting? What is your relationship to person whose record is requested? If self, state "self." s-e I ~ If attorney: Name and relationship of your client to persons whose marriage record is required. DOH-301 (3/93) 5/d7/0r Please print name and address where record is to be sent. (PLEASE SEE REVERSE SIDE) . CLASSD ~~ \ ,. ;'''RUNDLE .HBI}.lfI!lER, "", ' ", Ti:R.'~ EE~ 01-2.,1 EYES:..4Jr: '5-02 'f:'NONE W",' R: NONE ~ ;: JSSlfflD: 05-05-06 EXPIRES: 01-20-13 76937881 Application to Town/City Clerk for COe}' of Marriage Record :.:::::::::'::':..:::.::..:'::.:':::::.:,::::::,::i:i:::i:i:::.llel:::II::::g:IIII:I::.:mlij,III::::tIRII:::mi:!)::;:.;::,.:.:::::.:i:i'i:::,!::j:.:.:iL::::,:,:,:,::....:.::'::::::::::::::::::::::/::::\.:: NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section .......... -................ ....................................................... ...................... ... Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy W Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. . . . . . . . . . . . . . . . . . . ................. .................. ................. .................. :.P:I;IIII::j.llmlll::.:~IIM':.III::::R:i . .EE:. TOWN CLERK .................. ................. .................. ................. ................. ...................... . ....................... ........................ ....................... ........................ ....................... ........................ ....................... ....................... .................. . PLEASE PRINT OR TYPE Name (First) of __ Groom . , /-IO./'1l II Groom's Age or Date of Birth Residence of Groom (jUTC H f S S Date of Marriage or Period Covered q I by Search i ~ Place Where Ucense Was Issued (Middle) (Last) IIJJ w o//5tf. 11 otJfl1T 1/'//C,'l (County) (State) .Ny J99;;2 .. :::::::::.:::::::>:.:-:. .......... . ...... .......................... . .. . . . . . . . . . . . . . . . . . . . . . . . . ..................... (First) (Middle) J I/- >' (Last) /lOtlS H Name of Bride HC)L L Y Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (State) (County) O/lA ""'6 E NY WA//J/(OEI1S For what purpose is information required? OJ Vt)/l(~ In what capacity are you acting? What is your relationship to person whose record is requested? If self, state "self." SEt r If attorney: Name and relationship of your client to persons whose marriage record is required. Signature of Applicant ~ ~~- Address of Applicant 'i JEffl/bY /tJ'tCE J3fAco.-v d'Y JJ..sof DOH-301 (3/93) Date .5 / 9 / ~t)() f Please print name and address where record is to be sent. yvIh (PLEASE SEE REVERSE SIDE) . - ..."",...,-.--.-...~-------~-.,......-~_....--.-.-.....-~..~^.---_.."-",-~ -- -".;~,..,.... ~ :>J'F,\/\l l'()f ~..~ ,0.... nnrnR. . . 'L' T:C' "E.'N' TS'.E' , ~mrnt'~om~rotM('){m\ffli:tiCIil5 .... 1.:'-1" ....~.... -.. .." '.I:.. l..., 10:762973 829 0081&" -o4-at. PA1)\fOR.. 43e'FFERJrf" :, '''SEACON'') .......12SlJ8.. \.;;" ,SEX:W1EyEii.' .';'i".. "......._......' .~. .'.' .., '.C. LASS..... :D.A;h~' r . \iE'."" IiL '8..... .. "'. ..",r;, '~SUJ;O .,.21..02'~~E~ES: il7-04-19 . ~,........-...-., '61303290, > .~y';;;''' NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for COe>' of Marriage Record :::::;:::::;:::::::::::::::;::::::::::: .. ..... ..... ................. .................. . . . . . . . . . . . . . . . . . .................. . . . . . . . . . . . . . . . ................... .................. ................... .................. .................. . . . . . . . . . . . . . . . . . . . . . . . ...................... ....................... ....................... .............................................. ....................... ....................... .............................................. . . . - . . . . . . . . . . . . . . . . . .;mM~E::.~1; R.EO()R.D IE~~~'....-tt!IIPk.Qnij)::::.; ................. ...................................... . . . . . . . . . . . . . . . Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marnage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy D Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. ............. ..... .................... .................... .................... ...::::::I~~.II~::~m.BIIII:]tI81:::~III::::I:III:::111.:::::: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....... . . . . . . . . . . . . . . . . . . . . . . . .............................................. ....................... ...................... .. PLEASE PRINT OR TYPE Name (First) ~room PhflAe IN Groom's Age ) 0 or Date of .5 ~ lq Birth Residence of Groom Date of Marriage or Period Covered 1"'1 CL 'f by Search Place Where Ucense Was /Jar;:'/ "2 Yr~' Issued {/ (Middle) fo h '" (Last) :E IC-c Vl/I (State) ;1JY (County) j)J klu 5> /% ZOO 2- ;:i.. /~ / ~ Y In what capacity are you acting? signatu~~_~~nt ,_ 'J -?~~t'!0 ~j r D/1a~'(f!/ Address of Applicant /6 5ur;5CI ;2. ~ 0/ lib Ie ( /-(:"r/'CA U /JY /i--C;-1-1 DOH-301 (3/93) . . . . . . . . . . . . . . . . . . . . . . . . . .......................... ........................ . .......................... ......................... ..................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................. ..... ........... (First) 1:b k) n (Middle) fYlv {, e (Last) ~Ylc.; z..z...o Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where 1 _ . / I / Marriage Was M (}Y1 frO ~ / IV I Performed /0/2-6/7'1 (State) ;tIV (County) tJ~ ~ Iv. sir (' What is your relationship to person whose record is requested? t~elf, state "self." , cSe-l-<= Date-.5/9 t?Y Please print name and address where repord is to be sent. fYlc..1!-k tV '8 rv. '""7 d /- /6 ~ .....5.e.J p,r-/C:~ f e I ;It,o Ie A.J Y / z- <5 ?-I (PLEASE SEE REVERSE SIDE) .. - ?,rvc ~ ~~:-:_ J~~--~~~:'~ ,a;~" NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for COe}' of Marriage Record ................. .................. ................. ... ............. ................. ................. ................. ................. ................. ................. ........................... ................. . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . ............................................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........................................ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . ................................ ............................. .... .................... ..I,..'::::I:::I:.IIII::::II..I:IIII'g::IIIJ,III::::(11Iil:::1111.::::.:.::::::':::::::::::::::::::::::::,.':... ..................... ...................... ..................... ...................... ..................... . . . . . . . . . . . . . .. . . . . . . . ..................... .... ................ Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy D Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. ........................... ........................... . ........................... ............................ ........................... ........................... . ... .................... ..,:",...:I:i::I_I":I.II_I::,:ftIIM::::III::::I:II~I:::111:::::::::.::::'::'.':':'. ... ........ . . . . . . . . . . . . . . . . . ................. PLEASE PRINT OR TYPE Name (FJrst) of ~ Groom t nO . ?75, Groom's Age or Date of Birth Residence of ~ ' ' Groom ) ~~cJ"" c::f< Date of Marriage or Period Covered by Search Place Where License Was .. Issued ( O\./-J f) (Last) \. (State) For what purpose is information required? ~ b &,Je, C~\,_:J Cl-<..-.:.k ~v( DuC ~IYS In what capacity are you acting? Name (Middle) of Bride "~'\ Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage wasJ! . ~ ) / _ Performed GZJL. (Last) C~l L "l~ What is your relationship to person whose record is requested? If self, state "self." SR \-\- If attorney: Name and relationship of your client to persons whose marriage record is required. Signature O~liC //7' ...--" / ?Z Address of Applicant ';)d.. <5tcc \, \- ~./c C:l )\.... :~,),} . - J". V'J-\\~ If'} .) lc\~'C\l) DOH-301 (3/93) Date " S 1<.. L~ Pie se print name and address where record is to be sent. (PLEASE SEE REVERSE SIDE) , . NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for COe}' of Marriage Record ..................................................... ...................................................... . ... ..................................... ....................... . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . .............................. ..............................'.......'.... ii'illll::.II:::'I:IIII''''.:III''III:i::'11I91:::IR1:::':.:!:!:.:!:!,'.!,!::::,,:!":i' Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marnage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. .............................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............................. ............................ . ......................... . . . . . . . . . . . . . . . . . . Search and Certified Copy 17\1 Fee $10.00 ~ per copy A Certified Transcript includes all of the items of information occurnng on the original record of the marnage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. .................. . . . . . . . . . . . . . . . . . . . .................. .................. . ................... .................. ................... .................. ................... ,.,'::':'1'.:111'::11111111::1;111::::111::::11:111::'11II,:,::::::::\::.i,,:::::i'::.:i:,\:\:.'.:\::,.:.:::\:',:\:':' .............................. . . . . . . . . . . . . . . . . . . . . . . . . . . ....................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .............................. . . . . . . . . . . . . . . . . . . . . . . . . . . . PLEASE PRINT OR TYPE Name (First) (Middle) (Last) ~room N \c\10~~()6s~ \JO\~'\<Z-IJ'V'-- Groom's Age or Date of d Co \ d.- \ s \ ~ \ Birth Residence of Groom Date of Marriage or Period Covered by Search L-[ ~ cl~ - () ~ Place Where License Was I , \ Issued \...;\JCV1"J:')l \ (I " (County) '~4 c...\~ (State) NY For what purpose is informati<;m required? H~ , "'b H V-~\S0..so-..\\C3- \)mv.dv In what capacity are you acting? se\~~ (First) (Middle) (Last) r r\C e.LCft- wk.. ~ ",-" \1(Y\~d Name of S' Bride \1 e.ex"'lc..... Bride's Age or Date of &/_ Birth I....Q Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was 6Q'S~ C<::.h\011( :;,1 Coll.l.vy\k)('~ Performed (County) \) V t~~ (State) l\jf What is your relationship to person whose record is requested? If self, state "self." ~eJ \= If attorney: Name and relationship of your client to persons whose marriage record is required. Address of Applicant Lr5: t--1,ddld-:A.1::.hK,-l LI,J cci'P f)cfy:. (cd Is > ,f\,))I I J.S ';0 DOH-301 (3/93) sllL/Jor Please print name and address where record is to be sent. ~heenc~ ~ VG\lLVy\C,JIV\... c (PLEASE SEE REVERSE SIDE) .,~".,.'" ""~"- '.....,-,,':,.."", '. .- ....".. 10:949 229 200 CLASS D ~o-Ub , f EYES .~:nr'$os 'i::\'NClNf _1~">,~ R: B ..." 'e ISSUEb 08-10-06 EXPIRES 01-06-11 Il20808CIl Application to Town/City Clerk for COe>' of Marriage Record ':"'i:.II';'llii.:llml~'I:,;j!~i~III;'itgtls~'i~Ip"lli',,"i':.:!"i:ii,..:." :::::"""":""':""" ... ....:..::.....:........"'.,. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section t,.,.:...... :.;.;.;.;.;.;.:.:.;.;.;. .............. .-,-.................'.............. ............. ..... .'............................,....'.... .. .. ":""; .:;::;::::~:::::;:;::::::::::;:::;;:::: .......:.:.;.;.:::::;~:.:.:.::;::::::;:::::::.: .........-.-:...;.:.:.:-;::.;.::.;.;.;.:-;.;.;.;.:.;.;.;.; . .......;.;..........-:...,..... Search and 0 Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy O Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. .................-. .................... ...................-...... ......... .-.... .. ... .......... ... ..,.................... ...... ............... .....-..-.. ........... .... .. ....... .::I:',i:j,i,i:',',"".,:'......:;;'i,.',........;i..':::.i.:::.,.i.i.i:;,:;;:::;.~.gi',~~lllgl...'ftI81..llm:.:rill~1.:'JffiII:,.i!i!'l:....,in :::::::::::::::::::::::;::: ................-_.............-....,-.................... ........................... ......................... ::::::;:::;::::::::;.;::::::.;.;.......". PLEASE PRINT OR TYPE Name (First) of --rJ Groom I VIO,lZ1 Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was 7i l1/J/) Issued (Middle) (Last) c...b ~V\ /;( t ~ J - ZC( - f1'72- (County) DJIJv, s 5 OfJ /2'1 07 Waff/~J (State) Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Mil 5 Marnage Was Performed (First) ~C(Y1hOYJ /2- (Middle) Ph firs (/lIlL 11- 11?Z ( L.ast) (Co~nty) M~ss N/4 (State) ;V tf/JS'/QYJ , For what purpose ~'5 information required? ..~1!f!-/~~ Itc~l/lse In what capacity are you acting? ~~ Address of Applicant r Z OS.f:xy;y LuYj? (""Irs f!,I( tv( &// /fl/f/ fit If 5'( NY IZS1t> DOH-301 (3/93) What IS your relationship to person whose record is requested? If self, state .self." J--t f F If attorney: Name and relationship of your client to persons whose marriage record is required. o//30/{)1 Please print name and address AE (5 ({I"'< ) APR 3 0 2008 (PLEASE SEE REVERSE SIDE) .. 72'1l1231O~ . ...J' NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for Coey of Marriage Record ..." -... - -... -..... "',.....-......... .................. n.___............. .._--............. ...----............ ......,........................:.............-.. .. ...............-............. ...... -............." - -.. -.. ..-...,...............,.,....... . . ..:.i..:.I.::.::IIIQBI:.I.~R.:if_I.:.J:::=:.:::=: ... Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was Issued as well as date and place of birth of the bnde and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy ~ Fee $10.00 'A-1 per copy A Certified Transcript Includes all of the items of information occurnng on the Origi~Eee.~~e. A Certified Transcript m.ar be needSC2.N1ere proof of parentage and certain otllfW'Retiil& jUlation may be required such as: passports, veteran's benefits, court proceedings, or settlemer~a1:.RK ..... - - -....... -...... ..-................ ::.::..::::::f.lIRI:':;_Blgl..li:.lIg.:J:JIII=ftll:.j. :.:-;.:-;.:.:-:-:.:.:. .... -.. .......... ..........,..-,.--,..-............-. . .. ...... .. .- - .. ....... ..- .... ..-......._-- ................... ...........-................ .. ......................-..... ......................... ..........,........... .......... -... . PLEASE PRINT OR TYPE Name (First) ~room 'h\cK Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where license Was Issued (Middle) (last) e -03 (State) ! \~~ N '3 For wha.t purpose.~. in rmation required? lr.-t Ol1tx1\ ..---11&'i----~(f_---- In what capacity are you acting? Address nt g- 'be \4\1'01- P~~f6te " DOH-301 (3/93) (First) (Middle) tJeJh d - ?)r to 1 (County) b a;ftj\Q ~.. ('0/4 ( Last) 'TrernsejYl Name of Bnde Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (State) N NY What IS your relationship to person whose record IS requested? If self, state .self." ~e\f If attorney: Name and relationship of your client to persons whose marriage record is required. , ~ J,3-r() g Please pnnt name and address where record is to be sent. (PLEASE SEE REVERSE SIDE) - .. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for Coey of Marriage Record ..................... .................... ..................... .. .. .................. ....................... ...................................................... . ................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................. . . . . . . . . . . . . . . . . . . . .................. . . . . . . . . . . . . . . . . . . . .................. .................. . . . . . . . . . . . . . . . . . . . .................. . . . . . . . . . . . . . . . . . . . .................. ................... ...... .:::_II:::II:.::I:IIII:I::::III~III:.::[llIql:::19il.: Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may BECE;I)tE!J marriage occurred. ..-- "" - -'.1'" Hr"" l ~ , \...' .. ............... .. .... . .. . .::E)GItIlwETE:::eIRlr:IID)Fe:iiMlfEEE)))))i :.:.:::::::::.:::::.::::::;:)f:::.::::::;.;':':'; ; : : :': : ;~:~::.:.;.;::. :.;.;:~::.::~::::.;.}~::.::~:~::::.;::::;:.~::.::: ::;;.;;;:~:~::.::::::::::~::.:::.;.;;;:f~:::~::-: ::.;.;.;::.:::.::::::::~::.:r:~.. :::=::. .:.:'. .: ::::::::::::::::::::~:~;. . . . ..... .................... ... .... ........................... ..................... . . . . . . . . . . . .. .................... .................. ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .............................. .................... ............................. .................... ............................. .................. ......... ............................ ............................ ............................. ............................ ............................ ......................... ... ........................ ..................... ................. ................. PLEASE PRINT OR TYPE Name (First) of I Groom R L Groom's Age or Date of ,.- ~ Birth ::> Residence (County) of -;----. . . Groom -J '-.)Ii'1..e'-1/'r- Date of Marriage or Period Covered by Search Place Where License Was Issued (Middle) S. (Last) CH-v' (State) t--J- "tlqlg L0 PJ?p( ~G~L For what purpose is information required? . ~'~i In what capacity are you acting? SC-L-'F Address of Applicant A ~ {Lo,-ltv} F\ '0 '^ y- \ l to '- DOH-301 (3/93) . . . . . . . . . . . . . . . . . . . . . . . ....................... ....................... ...................... . ....................... ....................... ...................... . ....................... ....................... ... ................................... . .................................... . . . . . . . . . . . . . . . .' . . . . . . . . . . . . . . . . . . . . :.:.:.:.;.;.:.:.:.:.:.;.:.;.;.;.;.:.:.'.:.:.:.;.;.:.:.:.:.:.:.:.:.:.;.;. Search and Certified Copy D Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marnage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (First) (Middle) K'c.llIW( Sl (Last) (County) \) " -\- (Lv/.) (State) ~" UNlhJ 0tt-tw0~ What is your relationship to person whose record is requested? If self, state "self." 2ft If aUtney: Name and relationship of your client to persons wh~ marriage record is required. () Z (PLEASE SEE REVERSE SIDE) ~~,~ ""I"'1"<""~ ,. ?:"...;d "-' 1. .~~ . . r>.u1~ CDmf1'llSS\onf'f 0\ Motor l)enlCle:, 10:985 383 684' I'\\L.. ,J1li\.' . . X"Q' 1 lrE~.;.t: ..... .'; ,[.",1' .L...."""'-'. J.. -~ t...--- DOB: 01-03-'55 CHU,CARI..fS. 725 ROUTE 91 FISHKILL NY. . 125~ sEX NI EVES: BR^fff:c>"5-O&.CLA$S: OM f~SUED 12~''''~:Rts: 01~11 O-......t.~ 55533260 , RECEIVED APR 2 4 2008 NEW YORK STATE POLICE TOWN CLERK TROOP K HEADQUARTERS 2541 ST RT 44 SAL T POINT NY 12578 FROM: Inv Marcus Walthour FAJ(:845-677-7419 PHONE: 845-677-7375 TO: TlWappinger FAX# 298-1478 DATE: 04/24/08 NIJMBER OF PAGES (JNCLUDINGTIflS COVER PAGE): 2 SUBJECT: Verification of Marriage COMMENTS: NY State Police are conducting a background investigation on Laura Anne D'Angelo - maiden- Brown. As part of this investigation, I bave to verify this marriage. If you could please verify the foJlowing and fax back to me as soon as possible, it would be greatly appreciated. A release Is attached. Groom - Christopher D'Angelo Bride - Laura Anne (Brown) Pollack Date of Marriage - 08-08-98 IAKation - _Saint Mary's Is this information correct ~ No If not please explain }J/A Your Name '~f\ C 1I1/tS1f~c>-'l I Your Title (Ow^ Cj,.~ Please fax back to above as soon as possible - thank you. I . d XH~ i3r~3SHI dH Wd9~:~ 8002 ~~ ~dH ~ 'l-, '~''<''t' ~(IiIv. MI3) NEW VOItK STATE POIiICE 1220 .~ A__ "Nag 22 Aiba,., New Verk 12n6-2~2 AUTBOItlZATlON.fOR RELEASE OF' INFOJIMA nON - APPLICANT TO: The u.s. ArmDGlf~.Mari&i$e ~~ v...~. ~i~ ~ Service Administration; Any A~ Delia. ~. Prin6tpa1,. o.idIIaec ~.Of .autbOrit.ed pencm at any: School, College, Uniwrsity, Business Sc.boo4 Trade School, ~ or alhScMol; . AlIyLoGel, State or. Federal Law EAforcamcot Aptey; .Aay Past' QI" Present Employer. Any CRdit Bureau or Retail Membaut's Associatioo; AIJy Bank or Ymancial Iutin.tion~ Any Insunmce Company; Any State, County. or Muni(jpat 8un:au ofVdaI S1atistics Office; Any 0rKmulcc Committee or ,DiSCiPJinaIY Committee; 0Iber; , ,. . I, ~JlS<A VI~-4 ' have8PPl*l foraupJoymcnt WidJ,~ NewYotk State Police. lamawaretbatmy CIlIire back&mmd will Ge~Y~. I bcteby ant:barim aad ~._ ~ f.<) an.audIotized repl~utiYe afdle New York State ~ allY and.all information }'OIl haw_ COGCCIDS me~ iDducIina ~ic tIw1scripts, disciplinaJy matters, ud lftbe posdlm for'which I amapplyiDg is that of a police ~t sealed ROOfds pursuant to Section 160. SO( 1 )(d) of the NYS CriIIIiuaI Proc:ecIlu-e Law. 1'Ids authorization. 01' a rt'fJfOCIuc:tio 1hcrco( sball remam in effect for a period of one year &om. the date of execution of this docul't1Cm1. The position for whid11 am applyiDg is that of a poli~ officer. (1DiIiaII) Dan: ofBirlh: ,1 () . t\. '" 'r Place of Birth: .J~' ~ ~c.en;, ~ Social Security Number: thO . '.~?-. O~ Selective Service Number: Service Number: day of~F" L ,2~ ~~ SigoaIure A.nnfd Forces Manbersbip: Given UDder my band this ( (., I!IiJJJmil~ PLEASE SEND REPL Y TO: 2-d X~~ i3r~3S~1 dH WdSv:2 8002 v2 ~d~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for Coer of Marriage Record ................... . . . . . . . . . . . . . . . . . . . . . . . . . . . .......................... . . . . . .. .................. .......................... ......................... .......................... ......................... .......................... ...................... . ..................... .................. :.:I:.:I:::.:I:.IIIII.:B:I::I:IIII:gl:I:III~III::::tll191:j:II:11 . ................ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...... ... ...................... .................. ..................... .................. .............................. ............................ .............................. ........................... .............................. .... ....................... ........ Search and D Certification ,6ee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy I)J Fee $10.00 per copy A Certified Transcript includes all of the items of information occurrrng on the original record of the marrrage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be A~~~~ports, veteran's benefits, court n:B~13f ~ment of an estate. . ... ............................. .............................. ............................. ........... ................ APRi .1.::.jlj:.....:.e:II.I:::IIIIIIII:.::fll_.:: ::::::.:::I::II~~::".::.::::.......;.;.:.:::... ...................... ... ............................. .............................. ............................. .............................. ................. ...................... ...................... ...................... ...................... ...................... ...................... .. ,"". ................ ...................... . . . . . . . . . . . . . . . . . . . . . . ...................... . . . . . . . . . . . . . . . . . . PLEASE PRINT OR TYPE Name (First) (Middle) f ,.'~ I 1 Ir o "+' 1 '1 Groom -J I (' v'-C II Hr1 ,f, vJ Groom's Age "'1 / I' I or Date of ., 10 1 0 Birth Residence (County) f r., o ~ \ ...!-'C I ( Groom \.-/ \.ll he Date of Marriage c/ I or Period Covered b / I o. 0 ~ by Search Place Where Ucense Was Issued (Last) S'v I UrY)JY) (State) '~~ 0 ryi (\ry(~ (tl fls) ,^1 ................ . ................. Name (First) (Middle) of --r- ~ Bride ue Sle ' )', VI ~;ig~~ ~fe 1/// 1'7 L/ Birth Residence (Coun ~fride Odic - s ~ If Bride Previously Married, State Name Used at That Time Place Where \ /\ . (' /) ,J! 'IV .0 Marriage Was \ f'J C. (0. /1 i .~ (".De) J'Jt h r.Qor ~ '- Performed q :J.) J.. f-. l v l!lT ' I (Last) I CO'jt{? I !J (State) For what purpose is information required? { . 't ,7 I' -,,{ ~'-" ~f()(f(('Jlll~J In what capacity are you acting? J,11 " .,77L 1T:ft!J/i/ What is your relationship to person whose record is requested? If self, state "self." S{ It If attorney: Name and relationship of your client to persons whose marriage record is required. Date 4 IS/ lJ '6 Please print name and address where record is to be sent. RECEIVED APR 1 5 2008 (PLEASE SEE REVERSE SIDE) TOWN CLERK DOH-301 (3/93) '<<;;;o:",*,.,~ '--J" ~""""",,,""--",,-----.-....-,--, ---~--~ . - - - . ,-;;.--A-o" -~ ,74ll&o4fo . ~~_.,;,;Iji.J NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section ARplication to Town/City Clerk 'for COfry of Marriage Record TYPEOFRECOADr:llSSIREO(ChkO)< ..,. .'.. ':';';':" ,,: .... .."< . ". : ''''>:'. .:. ..',. . : ,..,. .,.<.. . ...., ." ",. '. . .' 'ec,... n.e, <,.. >::::::::::::::::.::-::.:;:::>:-:::'.:::::::::::::::::::::::::::::.:::.:::::>:..::::::::::::::::',-::,:::::::::;:::::<::>:':':,:::':':>:::'::::::::::::::::::::::/::"::'.<:-:::::'::::::::::::::::::-:::;:'-<,<-::::::::::/ ,:::::' Search and D Fee $10.00 Search and uzr Certification Certified Copy Fee $10.00 per copy per copy A Certification, an abstract from the marriage record issued A Certified Transcnpt Includes all of the items of Information under the seal of the Health Department, includes the names of occurring on the anginal record of the marriage. the contracting parties, their residence at the time the license was Issued as well as date and place of birth of the bnde and A Certified Transcript may be needed where proof of groom. parentage and certain other detailed information may be required such as: passports, veteran's benefits, court A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate. PLEASE PRINT OR TYPE Name (First) of W Groom lLL.iA-w. Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where license Was Issued (Middle) Pe.eO~IC t:5 (Last) ~L-E 03/27I{q2~ (County) bu.luuS0 (State) ~~ yo-zk 8 l Cf Lf-q Rt[(s I tJ1 Dc fo beJ In what capacity are you acting? A4'nMO~ - .__.._,----~~_:_-~+----~--- Name of Bnde Bride's Age or Date of Birth Residence of Bnde If Bride Previously Married, State Name \.J I CL.. Used at That Time Place Where ~ ~ r PfeS~h-t\-OV I~ CI-tUt.d.L Marnage Was I.fI. V. r_{ \ . Performed y ~ \ 5 \"VI. S (First) GLbKrA (Middle) (Last) G rttZl---l C. C &c5lH 02./ICi) rqZG (County) l>~ss (State) ~U V crr.k. What IS your relationship to person whose record IS requested? If self, state "self." 'j &r\ D~~~~---- lL.- Date 4 ( lk/08 Please pnnt name and address where record is to be sent. IN \ \ I \Ov~ F. Boq Ie ::To/" ,~;., (6. trd~ 6aUflt1/d eLl/d.1 r~q I LIJl 3S MoJiu.;t. ~ t e. 12 0 .-32-9"S- (PLEASE SEE REVERSE SIDE) Where to Apply for Record of Marriage 1. License Issued in New York State (Outside of New York City) Year of Marriage Apply to: * 1880 to present CertificatIon Unit Vital Records Section P.O. Box 2602 Albany, NY 12220-2602 * 1880 - 1907 and license issued in the cities of Albany. Buffalo or Yonkers Albany: City Clerk. City Hall. Albany. NY 12207 Buffalo: City Clerk. City Hall. Buffalo. NY 14202 Yonkers: City Clerk City Hall Yonkers. NY 10701 2. License Issued in New York City Apply to the Borough office of the New York City Clerk that issued the marriage license. The location of these offices follows: Manhattan - Municipal Building. New York. NY 10007 Brooklyn - Municipal Building, Brooklyn. NY 11202 Bronx - (Records for 1908-1913 are on file with the Manhattan office) 1780 Grand Concourse, New York, NY 10457 Queens - (Records prior to 1898 are on file with the New York State Department of Health) 120-55 Queens Boulevard. Kew Gardens, Jamaica, NY 11424 Richmond - (Records pnor to 1898 are on file with the New York State Department of Health) Borough Hall, St. George. Staten Island, NY 10301. PLEASE NOTE: Records of marriages in areas of the present City of New York. which were not part of the city at the time of marriage, are on file with the State Department of Health. APR-18-2008 17:16 P.01/02 -... .-~. ------.--.--....---. --_._,._.-.------._--~--: SINCE ) 876 Adlnlnm/'rIIor CAROL ANN NEVlJ,LE ~---.---~-.-...-.--_., I I , IWgiOllal Office.' 30 FROijT STREET' P.O. ~OX 679 : MlIJ.BR()(I)K. f-l'Y 12545 845-671\.5539 m 84S-677~297 FAX 6369 MItt sTREJir PO Biox 366 ' RHlNEBE(p:..: . NY dm 845-8764091 TEIj. 845-8717192 F: BY APP()~: CLEARWAJ'ER. FL 314617 CHARLES J CORnALL Y (J966) JOHN J. GARTLAND. JR (2003) -AtLAjirtRAP'P~A- JqN HOLDEN ADAMS MJG:HAEL G. GAR11.AND VlNCENT L. DeBIASE PAU\1.. O. SULLIVAN (also FL) wn.lJAM F. BOGLE. JR ',RENA MVCKENHOUPT O'CONNOR . ALLAN B. RAPPLEYEA (also C1) LJ;AH J. BALASSONE KAREN E HAGSTROM WILLIAM W. FRAME A HERITAGE OF LEGAL COUNSEL BARDA VON BUILDING 3S MARKET STREET POUGHKEEPS[E., NEW YORK 12601-32lS 845-454.1110 TEL. &45-454-4857 FAX E-Mail: info@cgrlaw.\lOIII WWW.CORLAW.COM i OfCoull!Je/ MIL ~ON M. HAVEN (nli,ea; RlctHARD V. CQRBALL Y FAX TELECOPIER COVER SHEET Town Clerk, Town of DATE: 4/18/08 Wappinger FAX NO.: FROM: I ) 298-1478 TEL. NO. : ) 297-5771 TIME: William F. Bogle, Jr. RE: William F. Bogle, Sr. 3 (including cover sheet) ~OTES: Please find the letter you requested. Thank you. If you should have any further questions, please contact our office. ~ ORIGINAL WILL NOT FOLLOW D ORIGINAL WILL FOLLOW Please ~an (845) 454-1110 if not properly transmitted or if you have any questions regarding this transmission. OUR FAX NUMBERS ARE AS FOLLOWS: POUGHKEEPSIE MAIN OFFICE 5TH FLOOR: POUGHKEEPSIE MAIN OFFICE 4TI1 FLOOR: I (845) 454-4857 (845) 471 N4593 CONFIDENTIAL COMMUNICATION : THIS TRANSMISSION IS INTENDED FOR THE INDIVIDUAL OR ENTITY TO WHICH IT IS ADDRESSED, ANIp MAY tONTI,\IN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE CINDER APPLICABLE LAW. IF THE READER OF THIS COMMUNICATION IS NOT THE INTENDED RECIPIENT, QR ITS EMPLOYEE OR AGb'"NT RESPONSIBLE FOR DELIVERING THE COMMUNICA nON TO THE INTENDED RE4IPIEN)'", YOU ARE NOTIFIED THAT ANY DISSEMINATION, DISTRIBUTION OR COPYING OF THIS COMMUNICA nON ~S ST~ICTL Y PROHIBITED. IF YOU HAVE RECEIVED THIS COMMUNICA TJON IN ERROR, PLEASE NOTIFY ltHE SENDER JMMEDIA TEL Y BY COLLECT TELEPHONE CALL AND RETURN THE ORIGINAL COMMUNICA nON Tq, US AT THE ABOVE ADDRESS BY THE U.S. POSTAL SERVICE. WE WILL REIMBURSE YOU FOR THE POSTAGE. nlANK you. CORBALL Y GARTLAND AND RAPPLEYEA LLP FILE NO: APR-18-2B08 17:15 ~ORBALLY ~ARTLA!'lD AN~LEYEA LLP P.02/02 CHARLES i. CORllALLY (1966) JOHN J. GARTL.^ND, JR. iZOOJ) AllA:i E "'AnltHA JON HOLDEN ADAMS MICHAEL G. GARTLAND VI:,/CEKT l DEBIASE PAUL 0 St,;LL1VAS ("..,ro WILllAld. F. 80GLE, JR. RENA MUCKE>/HO~PT O'CONNOR ALLAN II. RArFLlYEA (alwcrJ "STHONY C. CARLINI, JR. (aIsoNj) l.EAH J. 6ALASSONE KAREN E. HAGSTROM WIL-[\A~l W. FR"'''E A HERITAGE OF LEGAL COUNSEL A/Jminim'(ltQr CAROL ANN NEVIL-LE ~CE 18}E.) RAIlDAVOS BUIlDI"C J5 1<\AHET STREET I'Ot,;GH~HPSlt, SY 11601-H55 l<<igi(J1IIlI Offices }O FRONT STREltT FC Box 679 MILL8IlOOK, NY IlH5 8'15671-5519 TEL S45-6776297 FU 845.454.1110 TEL. 845-454-4857 FAX E.MAll: lnfo;@c~rl.i."'.(om WWW.C<JRlA.....COM 6369 Mill ST1\En PO BOX 366 RllINEBECK, NY 12572 845-676-4091 TEL 845-8761192 FAX OfCmweI MILTO"!of HAVEN (",ired; RICHARD V. CORllALLY April 18, 2008 Writcr'~ ExtelU1ion: 205 Writer's E-mail: wfb@C.j?r1aw.com By APPOINTMENT, CLEARWATER, FL H617 Chris Masterson, Town Clerk Town of Wappinger 20 Middlebush Road Wappingers Falls, NY 12590 Re: William F. Bogle and Gloria G. Bogle Marriage certification Dear Mr. Masterson: As you know, I am the attorney for the Estate of William F. Bogle, Sr., who died on January 31, 2008. His wife, Gloria G. Bogle, survived him. For Social Security purposes, she needs a certified marriage certificate. I have completed the form and delivered it to you office, along with S10.00 in cash for the fee. Please accept this letter as authorization to send the certificate to my office. If you have any questions, or require any further information, please do not hesitate to contact me. Very truly yours, CORBAIJL Y, GARTLAND AND RAPPLEYEA, LLP WFB/dmb Enclosure Cc: Gloria G. Bogle TnTOI P VI? :~i:~\, O~.' ?~-:. J .;f~: '''~'\'\. 2of~ DR.I\TERLICENSE ID:582443,fr17 Do.B~OS-17.ev LEWlS,CAlmL.'Y'N;B .SSIW''TOP'D'PIlME '~GBRS'RlSNV1259D S6X:F'EVE$':lGF\'H'f;&iQ2 CLASS: 0 E: R:"'B k,' ISSUED 9S--u-os'exP!RES:lJ5-17'"111 ;/' ,-' ~_~~ .m04soo Application to Town/City Clerk for COe)' of Marriage Record . .. ... __. _.....H........ ........___.., ........-........ .."------ --............... . .---..-..-,.. . ..,',.....................--- ..-......... ":::.:,:":..,....".",'~#.r.ifE.::\Ae:nr:".AR..:ftftre..R...'rw'.l~'Wti:A~~i':,:,: ..................... }{::::r.\~f?'/!~!r-::::~-~:e'-fit2:e~: _..:~~~:y~t::::::EH~~~:\~~!~!t'I~W1J~f .... ....' - .......". . .. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Search and Certified Copy .... -..............-.. ..-........ ... .. -...... . -. .......... .........-.. ............ . ..... ................-..,....... Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was Issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. 171 Fee $10.00 ~ per copy 19 A Certified Transcnpt Includes all of the items of Information occurring on the onginal record of the marriage. " A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. .......q...... .. ..-................ - -................... ...................... ............ ...... ..... ..."....... .-.-..-..,"...... .---...................--. ............. ......... ...................... .- ................... ............................l..::@Rtl#':A::a-=;:c;QjIRliE're..iOlDlAlll..MIT..P.... ....< :.:.:::.:::::::.::::::::::::::::::?:{:::.:}::.....~::::-;-..:.;::-:::-.:..:.:.:.:.:.:.::;=;...;:c.:....-.:::..-:::....:;:..;:;.:.;:::::.:-:::-:::.:.:-.-.-:-:-:-:-::;:;..-;:;-;";"-;':-"::;-':;::::-'::""'-":::":';';':<'}'_.:::::....:=::...:.:..,-...:,:.:::;: ... ....,'........--.-.-.............. .......-.. ..........-.... ...................... . .................. .......-.-.-.-..............- .-_....-.-......,............... . ............ ..........'.-............. ..............--- .. ......'...'.......-.. .. .....................,'-. ,......... '-.......:-:...:.:.:.:-..:...:.:.:.:.:.:.:.:.:. ...... ............ PLEASE PRINT OR TYPE Name (First) (Middle) of Groom Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was Issued (Last) W J'()..J.e s J~foO For what purpose is Information required? --~a9. '!J. wv)"" In what capacity are you acting? G~..i t' CYlJ (First) (Middle) (L.ast) Name of Bnde Bride's Age or Date of Birth Residence of Bride If Bride Previously Married. State Name Used at That Time Place Where Marriage Was Performed ---J u.\ (C (gO (State) r FJJs Ie What is your relationship to person whose record IS requested? If self, state "self." I (J --~Lf-- If attorney: Name and relationship of your client to persons whose mamage record IS required. _' ... Margaret Winters 6 Windsong Dr. . .. Blackstone, MA 01504-1226 DOHTl<S ~: . j B Y: _~~_~.f.~l.._----- jj)Og tI. Margaret Winters 6 Windsong Dr. '... ' . Blackstone, MA 01504-1226 (PLEASE SEE REVERSE SIDE) rf1 AI.N4 K . w~'a~ ~ Oc:tcber 1', 2013 ~ M~SSACHUSETTS '. ' DATE OF SIRTll CLASS REST HEIGHT SEX DB 5-06F DRIVER'S LICENSE f"....~ NUUSER EXPIRES MARGARET C 6 WINDSONG DRIVE BLACKSTONE, MA ";1;"." 01504-1226~~ot.d1l.'. {U~ Not-v NlIic 01 ..., Commiuion &pna 0cIat:Ier 1'.1011 . . COMMONWEALTH OF MASSACHUSETTS Worcester, S S. April 4, 2008 On this 4th day of April, 2008, before me, the undersigned notary public, personally appeared MARGARET C. WINTERS who proved to me through satisfactory evidence of identification, which were drivers license, and is known to me personally, to be the person whose name is signed on the preceding document or attached document, and acknowledged to me that he/she/they signed it voluntarily and for its stated purpose. C-X-~ Notary Public: Alan K. Russell II My commission expires: 10/18/13 WCOtllilff....,;:i::" Pt;bIIt: ,lX. My CommiIIion &piMa o.-11.1Dta ... NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town Clerk for Col!}' of Marriage Record Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. rr=t:J. Fee $10.00 L.LJ' per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. Search and Certified Copy A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. ,.,.-......'.................."...,.........-.....................-.,.........................................'.'.......................................................".-.........................................-.,',................................................".. .......-. . ..-,.....-........... ..... .............................................. .................... .................................,.., ....................... ............................................-........'................,....,.,......,......... ................................................................................................p.....U.......S....A.......$.....e......O.....OM.. ............p.....U......S....I1. . S.........I;. ..O......S....M.............N... .O.......e......S...M.......I.m.......F....e...s........................................................... . .,.......,.........,.........,.,....... ... ".....................-......... .. ... . .. . .. .. ..... .... .... .... ........................,......... ....... ...................................... ....................,....... . ... ... -... ... ." . ... . ...... . ................................. ..........' ........................................-...................'......... . '.' .... .. ....... . . . .. ... . ... .. ... ........ .. ............. .............................. ..... ............ ............. .... ............................... ... .. .. ...... ... .... ...... ... ...... .. ... ...............,.......... ... ....~...........,........,.............. ...,......................... .. .' ... . . ... .... ..... ... . . ,.. .. ... . . ......,.................. . ...........--....................,................................ . ... .. .. ... . ... ....., ... ... ...... . .... ,................,.,..... .....-................................................... ..,... .. ..... .. ...... .. .. ... . .... .. .. .. . .... .. ........... .................., .. ..................,...,........................... ... . .. . . ... ... '.' ... . . ,. . ... . . ..... .............. ... ... .......................................'... .. ...., ,. ..... ... .... ... ..... .... .. ...... ............ ...... ..................................., .. .......... .... ............... . ....... ..... ............. ..... ...... ..,..... ...................,.. ......-.......-. . ,....................,...-......,................,............................... ...............................,.....,... .....'.-....'..........'.......'.... ..... .. ............... .................................................................. .................................. .................,............,..... ............ ........ FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps. There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits. (Last) Name 1\\ f\ (c]d ~fride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed PLEASE PRINT OR TYPE Name (First) ~room ,(J(~ \J \- () Groom's Age or Date of Birth Residence ~room D 'vA- C~ \' } S Date of Marriage or Period Covered by Search Place Where License Was Issued (State) \j 'J \ 10o~. w \(jQ...f\lC In what capacity are you acting? (Last) N \\{ (State) .s l "Jh.. Q ~ - If attorney: Name and relationship of your client to persons whose marriage record is required. MAR 2 2008 DOH-301 (3/93) T \ (PLEASE SEE REVERSE SIDE) VS-34M . CLASSD 4 'J ,* ':f: i &7MIn1~t "\.'>t___'~_ --,,,,..,......,...,:.!'~~_~_"'-;.~x""~.,~"'__^_r,.;.;_,i --,~%J!:,f~ _._,-~-'.~",~~-;._.~"!",~,c-"!'''','",,,-''f'~-''''';:!'~_~' Application to Town/City Clerk for CoPy of Marriage Record .. ,,,. ..-.,. . ,.' "... ..,..... ...,_...,. ' '.. ",....". ..TYPEOFFllEeOROpeS~RRr:>(Ch&g~One}...... "" NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Search and Certification D Fee $10.00 per copy A Cerliflcatlon, an abstract from the marriage record Issued under the seal ot the Health Department, includes the names of the contracting parties, their residence at the time the license was Issued as well as date and place of birth of the bnde and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy Fee $10.00 per copy A Cerlifled Transcnpt Includes all of the Items of Informalion occurring on the onginal record of the marriage. A Cerlifled Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. . . ....". .,.' ".". . "..."...., .'" .. . ......pt..t;,6.$eC()MPt...ET~fjORMA.fYOFl.E.M1TFEf$ ....... . PLEASE PRINT OR TYPE Name (First) of Groom Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was Issued (State) For what purpose IS Information required? DJ\ili1\L1 .-ltl.[~~1:' ;iU0' In what capacity are you acting? Name of Bride Bride's Age or Date of Birth Residence of Bnde If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (State) .~~_. ,dE MAR t~-- If attorney: Name and relatl ~bf 'fOIJrll:f~,V1o persons whose marriage record IS required. DOH-301 (3(93) (PLEASE SEE REVERSE SIDE) Where to Apply for Record of Marriage 1. License Issued in New York State (Outside of New York City) Year of Marriage Apply to: * 1880 to present Certification Unit Vital Records Section P.O. Box 2602 Albany, NY 12220-2602 * 1880 - 1907 and license Issued In the cities of Albany. Buffalo or Yonkers Albany: City Clerk, City Hall, Albany, NY 12207 Buffalo: City Clerk, City Hall, Buffalo, NY 14202 Yonkers: City Clerk City Hall Yonkers, NY 10701 2. License Issued in New York City Apply to the Borough office of the New York City Clerk that Issued the marriage license. The location of these offices follows: Manhattan - Municipal Building. New York, NY 10007 Brooklyn - MUnicipal Building. Brooklyn, NY 11202 Bronx - (Records for 1908-1913 are on file with the Manhattan office) 1780 Grand Concourse, New York, NY 10457 Queens - (Records prior to 1898 are on file with the New York State Department of Health) 120-55 Queens Boulevard, Kew Gardens, Jamaica. NY 11424 Richmond - (Records prior to 1898 are on file with the New York State Department of Health) Borough Hall, St. George, Staten Island. NY 10301. PLEASE NOTE: Records of marriages In areas of the present City of New York, which were not part of the city at the time of marriage, are on file with the State Department of Health. \ 1 --I .ORK STATE,.,_- , .. ...."<" " ... . ~. ">=,:2~. ~"-'-='--"~DRivER LICENSE \0: 132837503 CLASS 0 "'- YVl~ IV. \!L " AVILA,KELL'( ,L 'i~ANTHON'{ DR 0201 '". HKEEPSIE NY 12601 05-14-80 SE)\: F EYES BL ,n 5-04 E. NONE R: NONE ISSUED 09-12-07 EXPIRES: 05_14-09 80655760 " .'1 1 i <' NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town Clerk for COe}' of Marriage Record Search and Certification D Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was Issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. ......',... ...........................-....... . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . - . . . . . . . . . . - ............................................... . . . . . ' . . . . . . . . . . . . . , , . . . . . . . . . . . . . . . . . . . . . . . . . . . .................... .......................... . . . . . . . , . , . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................-.,..-........................ ....................................... ...,.... ............-....._---.................... .,., . . . . . . . . . . . .. .. - . . . . , . . . . . . . . . . . . . . . . . . . . . . . . ..'....................... d Fee $10.00 Lp per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. Search and Certified Copy A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. m:g.I..B@IQ.I~lm-lfflIIM:IIQRIMlmiie<: FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps. There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits. PLEASE PRINT OR TYPE Name (First) of Groom Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was 0 Issued L-J AeJ-1.'\./ .1 i> .l 5 f"l- / / s (Middle) (Last) () , f ~) l (A.YTiZ'v k) (State) (, ~? (County) L)v1Lk f-' S.5 .0 / / 7> Z )'-/7"'3 For what purpose is information required? VY\ l I / lA-it. :r"O In what capacity are you acting? -{l'i/'1l. Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (First) (Middle) (Last~ ;Iv::;k'f - . 7-f:)'i7! 0 II ~;) 1 1 (coun~) , :--. OltVl\l C' j..) t} rc/U)J').I r::: r::u( (State) What is your relationship to person whose record is requested? If self, state "self." u...) / (=: E EiVED . - If attorney: Name and relationship of your client to persons whose marriage record is required. ~, 2 () i~J,( e r7 l:':'\ 1 ( u-€- G....J (\.//0:1./1. ? ~ ) Pk)/5 k'1 /'2r5'o DOH-301 (3/93) (PLEASE SEE REVERSE SIDE) VS-34M ~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town Clerk for COe}' of Marriage Record Search and Certification D Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy ~ Fee $10.00 ~ per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. .-,...............'.-..,._--...............................................................................................................................................-......-.-.......................................................... ................................-,.......................................................................................................................-..................... ............................ ....................-......... .............................................................................................................e......b.....e....~.....s.....e.......e.....QM.............p.....U......S.....x....e........p....O.....S.....U........A.....m.....o.........e.....s.....U.......rr;.......p....e....6................................................. ............................,....._'....,'.....'.'........-.......................................................................................... . ..... .'. '.' . .... .' .... ..... ......... ........... ..... . .... '.' ...........................-.'...........-.........'.........'. .........,...-......,'.--.,.....-.,.....................................,............. .. ..... .. ....... . . . .. ,.. . .... .. ... ......... .. .. ....... ... .............,........................ ............................,...,...,..-..,...........,....,............................................................................... . ..... .'. ..... ........... . ..... '.' '.' ......... ........... .... . . ..' '..,. . .............'...........,...................... ........................................................................... ..... . ..... ... ................. ...... .... ...............-........ ..,'.........................................'.............'.'............................................................................................. ...... . ....... .'. . ....... ....... ...... ...... '.. .... '. . ......... .... ",'.. ..... ... ...................,.........".. . . ...... . .... ........."....... ........................................ .. ........ .. .. ....... ..' .. .... ... . .. ...... ......... . ........... ..... ............ ............... ........ . ... ..... .... ........ .' ..... ..,............... ......... ...... ......... . ...... ........ . ....... . ..........................,......."...... .....,..................................................................,....................... ................... ... ........................ ........ ........................... ............... .. .. FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps. There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits. PLEASE PRINT OR TYPE Name (First) (Middle) (Last) of J' - h r 5' \ Groom (\ h t.: In" eg. Groom's Age or Date of G \ - 2 (1 _ L I ~ Birth , Residence (County) (State) ~room D,~-frhe s <:, Date of Marriage or Period Covered ~SM~ 00-03-0~ Place Where License Was Issued For what purpose is information required? Pu')spord- In what capacity are you acting? NM'\e Chonqf tne 5tf{ ()() fXl~popf- .....................,......,..... ...........,..........,............. .,...... ...................,.,.... ...............................-. .............................. ... ................. ... Name (First) of .. Bride Deb ORah Bride's Age or Date of Birth (Middle) (Last) ,:j(.crjLe~ ,y O~rOL-(;v (County) Du.f t"e OS S (State) tJ What is your relationship to person whose record is requested? If self, state "self." 5 e ( f- If attorney: Name and relationship of your client to persons whose marriage record is required. Signature of Applicant b 6cV\c~ s- (,\~ Address of Applicant ~ . 55 SceniC /{ ((5 .DI!ivJ.. POltcfLeepsi e ( kJj rZ&03 DOH-301 (3/93) Date 3/1O}08 Please print name and address where record is to be sent. tfucr~ ~ OJ' 01tef(. 5"5 ScenIc fi)Us. bl(. PUlA hleeps;e J JJ /21t03 (PLEASE SEE REVERSE SIDE) VS-34M ,10:884 251263 CLASS 0 /JdM4cf~ 18218710 ._ .,.,....."".~_..',....i,;....",.'^""'''''''c.~.,__''''''"''',.-_w_=~,_.~'''.,..,-" -. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town Clerk for COe}' of Marriage Record Search and Certification ~ Fee $10.00 .l6J per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. D Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. Search and Certified Copy A Certification may be used as proof that a marriage occurred. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. ............--............"........-......................,'...........................'.'...................................................................................................................................-.................." '"' ,..,.,.,.,."",...",.,..,.,.".",.,."".,.",.,.".,.,.,.".,."., ".,.,.,.,.,.".,.,.".,.,...,.".,.,... ..'.'...'.'.'.......'.'.......6.......'.'.'.......'.'....'.'U...'.'...'b.'...'.......'........S....'.'.'.......'.'.....,.,.................,.,...."..,...,.....,.".......,.,.......,.....,.......,.......",............,......,..,.".,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,...."....",.,.,.,... e:~ilgEgl:,rtHIIDfjlftMIII:IIMmfiee:'''' FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps. There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits. PLEASE PRINT OR TYPE Name (First) of Groom Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was Issued T Ol.rJ.') o-f' W C; p pin 5(> r (Middle) (Last) (SiS iq (First) (Middle) A J ssq (Last) S is /q S. }O/4J<l2 (County) tyJ-tc her (State) 9/;;'1)79 (County) I) v-tcheJs (State) Ny If f3.ride Previously Married, State Name Used at That Time F~~WVhere Marriage Was Performed 1Jf) For what purpose is information required? pc;sspor+ What is your relationship to person whose record is requested? If self, state "self." w;+ e In what capacity are you acting? If attorney: Name and relationship of your client to persons whose marriage record is required. Signature of Applicant ~~, Address of Applicant / ;}. S~-f-ri"5 he IY) i2 d ' U () ;;.. J 8 L-~s ('G;YJseu11Ie N'I 1)!"40 Date 3 .5 0Z'" Please print name and address where record is to be sent. DOH-301 (3/93) VS-34M (PLEASE SEE REVERSE SIDE) ---., ~~ . EYES: :'S-OlI E _wi;, tR: lB ..,. . , . JSSUEB: 11..0'70()7 EXPIRES: 1_11 ",,"--_..~-----,_:_<,-.__... " " "ti""," -" ,"~'~ ~ _1 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town Clerk for Co~y of Marriage Record ...... ...". 'ii::mYPE:oFREcoRaDesiRED(Ch~Ek(jn~l:) ;:;:;.:.;.:.:::;:;:::::;:;:;::::;:;:;::::;::;:;::;:::::;:::::::::::::::::::::::~:>~:::::{?;:)>)~:}~:~:t::-:\::::\)(:.::;:;/::::>:::~::~:?{:<::::::::::::;:;;;;:::<:;::;:;:~::<~:.:;~::/::>>:::::;;::r;:;::>::::~::::::::::>::::::::::\::::;;;:;::::~~:::::::::::::;;:;::::::::i:~:::;:':;;:;:::::::;:;:/..:iH:i(){::::;::;:;::::::-:':'"...... Search and 1sJ Fee $1 Search and D Certification 0.00 Certified Copy Fee $1 0.00 per copy per copy A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information under the seal of the Health Department, includes the names of occurnng on the original record of the marriage. the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of groom. parentage and certain other detailed information may be required such as: passports, veteran's benefits, court A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate" P............... ;:;:;:;:;:;:::::;:;:;:;:;:;:;;:::. ................. . . . . . . . . . . . . . . . . . . . . ................. .................................. ... . ... . ......... .... ...})):}}}~tte>\A:s'.'.':'e{;t;:^:M'.":""'.pl:e''':O'ir.e:.:.:.8^RUAbb6e"'I:t.+eee} .......... :::::::::-:.;~;:~:;~~~~:~:~~;~;~;~;~;~;>\~:~~ :.;:::!!:.;::.:'~::~:~~: .'. ...:. ::::;g; :':)f~, ...:::::Q~"~i*t<:.:~~:[r.:::.;:~:!9r:rt:.:/.:.:.;.;.:f:irfFE5t?:~~..:.:.:.:.:.:.:.:.:.:.:...::: ::;::::::::::::::::;;::;;::::::;;:-:.;.:........ FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps. I nere IS no tee tor a recora to oe used for eiigibiiity aelerrninarion for sociai ~.~...'aT~ or veicldn":; U";fi;;iib. PLEASE PRINT OR TYPE \ V EO /0 11+1 (State) ;/( Name (First) 2 .~frid~:'" Fe I (S h ~~~e DJ u Birth /If - 1 Residence (County) of 1_ / Bride YV ~ If Bride Previous y Married, State Name Used at That Time Place Where Marriage Was /) Performed q::) r'O f) (Last) Name (First) (Middle) (Last) \ ~room D.s~t= rib lt~ h. hE Groom's Age or Date of /.1\ C\ Birth ,. I Residence ( ounty) ~room IV~ w YO r J'-. Date of Marriage or Period Covered C b' / / C1 '" .-r--- by Search Je J Place Where License Was I A J Issued r V '"'--\. r (State) For what purpose is information required? LA. 5', fC{i'$' f{)\,- T ~'e- L {~ In \..h~t c.::p:::c;:ty"c:.:e you :::ct:r-:g? S~.Lr d. ~ S- ~~ 5]2z, !Pt/e h'1-e NCC'vJ 10 r k-j IVy / Do3 r; Ap G-- Feb .;:; 1 ~'DO~ Please print name and address where record is to be sent. cOG,J':) S- ;11 A~.l t> Y) V1 E_ Ne vJ '10 rJ::.- j lVi / Of) 3/ ItPT I'V] Go DOH-301 (3/93) V8-34M (PLEASE SEE REVERSE SIDE) ~.;J/ /00 ~ 1J~~fn; ~~: ~,)~cu:c~~) . ;::-reu..--) ~Ov ~, ~ ~~ <~~L~.U ~ f~~ /7,~ ~' :;~86~ ~W.~~ ~ 'C_~\Y\ ~~ j fLo ) <9-00'b ''\, ~ \) \J\______ PA~RICI+ A. MORRIS NOTARY PUBLIC-STATE OF NEW YORK No.01M06134678 My Commission Expires October 03. 2009 ~~: ~~~ '~) >ti. i ,~ ~a ~~ -< .~ (,5 i'." ;'""";1 ~_.., J~'" -:- ). ,t,.,~ i,1.. ~:;;! :...~'. ..~ :".:.f :_'.. ...~''. ~ '. :~ 'r ':.11 l.t i,J.$ J ....!~ ~.....~ CY\ u ~ { ~-..J ~ ~ ~I( s::- ;J~i\!l \J \-') t .t '[~J~ '\-- ro ~ J-" ~ p t' rc ~1 ,~ ~ ~.r - ...:: "":: - - -: - - ~ - - - ...:: ::: -: - ...:: - ~ - - ::: - ."ct' o Q U ,~ D I-I ,ct- ..... I () irl I::t I!.' '1"/ .-' - --, --~. ~ C,_ '_,.____...-~_.._-.4_~.-.~-&-F'.V.'-.<".--~-""'7~"~-C.'''-..-~'6V~~-;-~.>1 NEW YORK STi\TE"'t cC:~~,::!~ DRIVEI~_LICENSE ":::--~~~-(:~.;-,^ 661~~5-~~~1 ,~i~_;,^: ,;1,: ~...,~ AS., R,AHAI.,..,rp....s..', EF .....'r. ~.)..; ..' POBOX g; ,~.,' " , " 'I. r .. NEW YOij,l< .~, NY~'.:L~oo:h ,;:1 SE?(: M EVeS: BR.'H'L~;CL~S: E r ,- J E;'~,',' .' R; ~%,"".'<:-~:i.t.' :'!- . ,,- '4 ISS.UEI?,:'~!1~~IRES: ~5:1~1~. ; , ~/~t2f~~~f.~E~51')1< . 41~70'1 --------- ,_::.;;~;';;;.~.:.::: .....,.._...__._-~;. .-:.'.'~:;.::'; ..,. ------- - NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town Clerk for Co of Marria e Record Search and 0 Fee $1 0.00 Search and 0 Fee $1 0.00 Certification Certified Copy per copy per copy A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information under the seal of the Health Department, includes the names of occurnng on the original record of the marriage. the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of groom. parentage and certain other detailed information may be required such as: passports, veteran's benefits, court A Certification may be used as proof that a marnage occurred. proceedings, or settlement of an estate. ...................................................................... ....................................................................... ...................................................................... ....................................................................... ...................................................................... .................................................................... ............................................................... ............................................................. ... ..................................................... . .................................................... ......................................,............ .. .............................................. ........................................... . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . ..................................... . . . . . . . . . . . - . . . . . . . . . .. .. .. ..... :p:.:<:::.t;(e:>~/:\s..:.:.:::E:>e::<::::O::>:'M:.:::::.:'p:':':'::e:(s:::m:::'s:Yp':::g:':::>'S::':':<<M:::(A:::::.:::::'::a(a':'::'::S<>M:':"'::':m<>e:E':<'::e::< .. .. .. ... ... .. ........ ... . . ... .. ... . . ...................................................................,........ ::~::..::::::...::::~..:.:.:;.:::::...:.;:..:::..:.;;;~~~~::::::::::::;;::::::::::::.:::.::~:~~:.::;:;;:.:.;.::~~:.:~:::.:.:.;;:~~~:.::::~::::;;;:::::::::::~:.:::.:::.:~~::..::::.:::::::.:::.:::;:::::~~;::~::.:~:.:.:.;;:.:::.:::::::~:~:.:::::~~::::::::::::.::;::.;.;.::~~~::~:~~~:::~~:~~~~:~:~::::::::~:~::~::;~;:;:::::;;::;:::::::::::;:::::::;;;;;;:::::::::;;::::::::::;::::::::;::::::::;:::::::;::::::::::::::::.::: FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps. There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits. PLEASE PRINT OR TYPE Name (First) (Middle) (Last) of 'D Groom v Groom's Age or Date of Birth Residence (State) of Groom u.. -\- eN S5 Date of Marriage or Period Covered -,) l by Search Place Where License Was Issued (First) (Middle) (State) For what purpose is information required? C' tw~ No. f\,u.. c,n N LA'S; nCj--_ L-'. C I'\Se What is your relationship to person whose record is requested? If self, state "self." Se\.f In what capacity are you acting? If attorney: Name and relationship of your client to persons whose marriage record is required. Date ~ dS/Qr Please print name and address where record is to be sent. c~v tA. t..-LV D t LCLV() ( ;?:> \! (t-e>fn fZJ.- cp ou-g ~l J62.a-PS" Q. f\J'l I 2 (p () ~ VS-34M DOH-301 (3/93) (PLEASE SEE REVERSE SIDE) <~ DRIVER LICENSE 10: 112 397 72.7 CLASS 0 "IOllARO,sARJI"M '<,<s.<<.<<<<v,<<<A'ET<.<< H 80$1'<< <<J. <,- (/). ... .:.:.., /: ,,< ~HKEEEtw121103 i~ 02-08* sEl<: F EYES l!iR .1i!I: 'iMl1 :E: 'NONE Wi;:': Rll "' ISSUED 10-29.07 EXPIRES: 02.(J8-13 _700 Application to Town Clerk for COe}' of Marriage Record NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Search and Certification D Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. ................................................ .....................................,........... .............."................................ .. ............................................ Search and Certified Copy r-;-l Fee $10.00 LLJ per copy A Certified ~sc:;;"inc~s all of the items of information OC:::::~,"~I~' ,. . :::;:::.P,ooIOI parentagei~d' celCtajn 0 detailed information may be required ~h as&ass , veteran's benefits, court proceedi~, or ~t1em~ of an estate. [Tj .......................e~iIIIQQIIIIIIEIIIIII.:Ie.I~lle\<::.::::::.:.:...... . .........................................,...... .....................-.............................. ................... ............-............. .................................................... ........ .............' ......................... . . . . . . . . . . . . . . . . .. ...................,........ ..................~............................ . . . . . . . . . . . . . . . . . . .. ............................ ..,................"........................... .. ............ ..... .......... ............. FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps. There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits. PLEASE PRINT OR TYPE Name (First) (Middle) (Last) ~room J ';C7t'v<:? Ai t~~p~ V Groom's Age or Date of ~ I/~Jd~ Birth '/ ) 'Y . Residence __ (County) ~room JJ H 7 ct 111-35 Date of Marriage or Period Covered / t;? by Search Place Where License Was Issued (State) )/ ?~) ---Vu//i/ 1la // Name of Bride Bride's Age or Date of ~ /,;) :1.. / ':13 Birth Residence .__ (County) of "7'1 _ Bride c:-f/ t( 7t! IIf::~.J.5 If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (First) (Mid9Ie) fJ (Last) J ~ /~ t;;':::t-y;J hll! ~;;:/.-lV/tit (Statey) j}' ::;~ CJrJ7f'6~;2~' 'A/( For what purpose is information required? ,/i?1' ;04?OC /?V.? /r- In what capacity are you acting? DOH-301 (3/93) What is your relationship to person whose record is requested? If self, state "self." C:;~fL- If attorney: Name and relationship of your client to persons whose marriage record is required, Date _I 1./ ~ ~ 5/'dtJt? / Please print name and address where record is to be sent. - ...~_.--- (PLEASE SEE REVERSE SIDE) VS-34M .~-(_.i I , ! ~ a ; Y~_d:/. , \. ,/-Y-7- ~ . . ~ -'.. . -'. . . - . .~ .1)2 . ., ms,,:i'T:" 1lIIiilhc' ,. dil: :B ",,'" , 'ISSUED: 12-29-86 EXPIREs: 02-28-11 ~ _i. _ '43_ .' " .. ./ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section _____" N Application to Town/City Clerk for COe.>' of Marriage Record ...... . ,......... ........................ ......................... .,..,'..,............... . ...--..-................ ... -... -.......... .. . , . ' . - . . . . . . . . . . . . . . . . . ... .............. ................ -. - -... .............. ..........,.... ...... -. - - - - - -...... ..................-................. ....... ..................... .................. .... ............ ......_____.._..... .... - ___.d.__'"' _ __ ___......".........._...._..........,,___.............. :~J.~~...g~I!I...I~~~SII.(lliiJ(Qpi~....m Search and D Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting partIes, their residence at the time the license was Issued as well as date and place of birth of the bnde and groom. A Certification may be used as proof that a marnage occurred. Search and Certified Copy D Fee $10.00 per copy A Certified Transcript Includes all of the items of information occurnng on the onginal record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such ~ ~~R.t~f"!i'i'I\an's benefits, court proceedlngft~[I!l~~f..bltate. FEB 1 J 2008 .... . ,. .. . .... ....:::..::::'::e~egE:::~.ml1jg.I~"::I,.I. PLEASE PRINT OR TYPE Name ./J (First) ~room 'ICbf,J<:t Groom's Age or Date of Birth Residence (County) of 0 Groom J:<:. .q nt' Date of Marriage or Period Covered by Search Place Where --- license Was /"" tV .IV' Issued I U (State) For what purpose is information required? ._-~~JL.___6lt2f--;(J;J2~ ^~-- In what capacity are you acting? ......"........ -.... -............... . . .. . . . . . . . . . . . . . - . . . - . . . . . . . . . ................,......... . .n__... ......... ... .................-... ..............-.... Name (Fir,t) ~fnde irA) !hIe-eN' Bnde's Age s;::; or Date of 3 Birth ReSidence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (Middle) (County) P?1 CJ,fS ':. O'f' E~sf -hi/, iil What IS your relationship to person whose record is requested? If self, state .self." Sf/If If attorney: Name and relationship of your client to persons whose marriage record is required. /X C x.atlifeen~ 2 'Berry 9liUPO_.251 !JvfountainviUe, tJ(Y 10953 DOH-301 (3/93) Please print name and address where record is to be sent. ~6ertC~~ x.atfifeen~ 2 f}]erry 9li((P 0 ~251 oun",am (PLEASE SEE REVERSE SIDE) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for CoeY of Marriage Record ........'......_....._..'.:.'.....-,..................-............... . n..."' .................... ...............................-.....'.......--.................-....,'...,.-......--.,'-.,........,..,','...-.....' ................. ..-.-............... '...---....,...,...... ................---. ..-.......-......'.......,............. .-....,................:-............'.:-....-....-.-..................'...._....'..,--....,...........,....'.....',..'....;. .........,.,.. ........ .--....,........ ...........-............,'... -";';':':':';'-::':':"',:-:-::':<-:':'"'':-.-:':':-:':':<':-:';':',-:"-:-;':-:':-:':-:';':-:';':':':-:';'-':':-: ............. -.-...."...............-...........-......... .....'...-.............................--................................,...... .,..........,........,";'.;:III.f.)!I.l~II;II.I.:.J:::...:: .::... ":::::.: ..'--'-,-..'..'...-.,. .,.,'.........'........ ......-,................:.................. .. ........- - -....... . . . . . ........ Search and 0 Certificalion Fee $10.00 per copy A Certification, an abstract from the marnage record issued under the seal of the Health Department, includes the names of the contracting partIes, their residence at the time the license was Issued as well as date and place of birth of the bnde and groom. A Certificalion may be used as proof that a marriage occurred. Search and , ~. Certi~ed Copy ;j il"Cl,/, G1-qC ~ Fee $10.00 IDtag t'er-$' O~ per copy A Certifii:! Transcript includes all of the items of information occurnng on the origInal record of the marriage, A CertifIed Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. .;.... ...... -: -~ .;." ;.;, ;.;.;-:.;.:.:.:. :-:.;.;.;. ;.;.:. :.:.:. :.:. :.:.:.;. :.;.:.:. :.: .:.:->:.: . . . ............ . .............,..-.. .................. .......-.......... ..................-...-.. .................. .................. .................. .................. .................. .................. .................,. ..-..............- . . . . . . . . . . . . . . . . , . .. ......... ... ... .'::II.ll;tIIlIIR"IBI;;III.:'fllll.I..:..:;):. ._..._..-.-............,................... ..... ......... ............,...... ..............,.....-...-... PLEASE PRINT OR TYPE Name (First) ~room - OriN Groom' ~ge or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was Issued (Middle) (Last) L ILL /$ , {)/f /1 g (County) (l1l';('OLL 6'1' (State) 11//1 For what purpose is information required? .. '10 JlEfi:/5TE/2 ;nAI?I? 1/16;E IN jJOuhV i) In what capacity are you acting? ~df- -~ Slgnatur of APPlican~... t;l,J ? ~ , {l'i / J Address Applicant lN~1 (30)( N WNIVI9 1; .335' ;;- /1/;--; OJ-:f6o DOH-301 (3/93) ...'.....,........ ...........-......... ...-..,............. ....................... ..........'..'.-....................... ..................... Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where MarnageWas (/tjJ-lGE of hlft/JrJ/lI6 E 1\' Performed rALL S (First) A LIC f/J (Middle) (Last) j( Ii TfJR2 Y/Y/l k (/ F;; o.g (County) (/tf(j('O L i (State) /1/H' y What is your relationship to person whose record is requested? If self, state .self.. <"-" - uC'L-/- If attorney: Name and relationship of y s whose marriage record is required. TOWN CLERK O#- (.Jr:f Please print name and address where record is to be sent. /tL /( 1 H L It L /5 '1fi< (/.4 /:30 ,/<:L?5 t: AI "'-'011/;"; /J Y NI-l IV. C /1 / , ~'::>/' U,--,<Jh() (PLEASE SEE REVERSE SIDE) JJc~-,-c_ m ,~~ I 0\ z..2..\. (;> <ci "'\ r ... NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for CoeY of Marriage Record .. .:1:::1::::.:1:001111:111::::1:11111:::1;111'=111;1:::.111191:':I_~,i.1: ............ .. .. ..... ......... ."-" ...... .... .. ... .... .. ......... .. .. .. .. . ..... .. .... . ....... ........ . . . . . . . . . . . . . .............. ........... . .......... ..... ......... ......... ....... ... .. Search and D Fee $1 Search and 00 Fee $1 Certification 0.00 Certified Copy 0.00 per copy per copy A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information under the seal of the Health Department, includes the names of occurring on the original record of the marriage. the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of groom. parentage and certain other detailed information may be required such as: passports, veteran's benefits, court A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate. .:::::::::::::::::::::::::::I:I;:.i::'II.lliil::':1111:':III::::B:ill:::lil:::::::::::.::::, PLEASE PRINT OR TYPE Name (First) - (Middle) ~room nil (;ilA-etJcsc;fll Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was Issued u . /;;{ . 6- ~ (St~t;> ;Vi \. (County) I )uT(} tIc~<: i-/ ' I of .-. Wfll'? / (;~,;d;J For what Rurpose is information required? f:e1Z So AJIt L In what capacity are you acting? Sign ure Ofj4'plicant 'aM L( Address of Applicant -s SL Lf77J pDIL.1 (/ t. J. .'. rJ' '--a.LJS,N . . . . . . . . . . . . . . . . . . ................. .... .............. ::::::::::::::::::::::::;~~~tr':':':'::::::::::::::::: ........... .... .......... .... ......... ...- ..... ..................... .. ............... ...... .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....................... . ........... ... ................... ................... JJ)irst) (Middle) (Last) . (! fJl2()L,y;J 13ecNDA Let<.,J,S Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name i2.dB.I /Z:;-f{ Used at That Time /.,Hr- 1'-1 v .... Place Where B /1 Marriage Was (! try or . ti./fl?(J{/ C c)u<T Performed 0' /7. t.f; 7 '''' (County) U t/TC tlc:;.S What is your relationship to person whose record is requested? If self, state "self." S t/'L-r E.O If attorfleX;..~me and relationship of your client to persons ~ o\e\rri~e record is required. /-f-;I 'Of Please print name and address where record is to be sent. (PLEASE SEE REVERSE SIDE) tJOS-Old)4'IU =~~:~rQ~ERf,c " MoYNt AlNtILt! ..NY 10953 SEX: M'E'fEiii)SRf i'lf: ~H OlASS tlM '~SJEO:ll~1:02 %i'~)(PIAES: 61-24-11 ltJib.l;:;!"~ ~ ., . , ~:>." 61ll622S0 , . t NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town Clerk for COe>' of Marriage Record ......................................................>>.......Hi\.imMIII.~aIRglg~I~UJI.g.~II:!ikml:I.),:...ii)....<><.........}}.:.:::....:.....:.:::......:............. .. Search and D Fee $1 0.00 Search and ITJ Fee $1 0.00 Certification Certified Copy per copy per copy A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information under the seal of the Health Department, includes the names of occurring on the original record of the marriage. the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and A Certified TranscriP~EJ~proof of groom. parentage and certain I n may be required such as: passports, veteran's benefits, court A Certification may be used as proof that a marriage occurred. proceedings, or settlemenf(!~ Os~t!OO8 ..eCeiSECQMRESl1s.msiIAii.BSMii ...................................................................................-............................................. .....................................,..................................................................................... FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps. There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits. PLEASE PRINT OR TYPE Name (First) (Middle) of Groom ( Groom's Age or Date of I I r ';;;. '1 ~ rJ 3 Birth I ( Residence (County) of 'A A Groom .yu S. S Date of Marriage or Period Covered by Search Place Where License Was Issued (Last) ? Name of Bride nS Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (First) (Middle) (Last) ('OJ{lo N'-- 16rdl- ~D (County) t-du <; S> (State) (State) p~ What is your relationship to person whose record is requested? If self, state "self." ,$.e...{ t:- In what capacity are you acting? If attorney: Name and relationship of your client to persons whose marriage record is required. - '7 - J-oog tl C~':'1 J/-n:J /}.JUfI/rtr5 k/IJ IU/j /,;;-srO Please print name and address where record is to be sent. VS-34M DOH-301 (3/93) (PLEASE SEE REVERSE SIDE) (0j\-- '. . NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town Clerk for COe.>' of Marriage Record Search and D' Fee $1 Search and 2 EJ Fee $1 0,00 Certification 0.00 Certified Copy per copy per copy A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information under the seal of the Health Department, includes the names of occurring on the original record of the marriage. the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of groom. parentage and certain other detailed information may be required such as: passports, veteran's benefits, court A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate. """""',.,.,.,..........}//.....y..m.....p,cs.isicO...PUETEFOSu.iNi.iEMimsii....................."'..,......UU............'.'..................'.'...'...'.'...,.,.,',','" " .. ................................................................................. .................................................... ............. .............................................................................................~............................................... . ............ . ................................"........... .......................................... FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps. There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits. PLEASE PRINT OR TYPE Name (First) (Middle) of 1'1') i R a s" 1>-1 {;:; Groom (..; rt (Last) ZIMN't Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was Guf) P P \ rJ 6E e. Issued 02/02/61 (County) ':0 UT ot t. s. s. (State) N .,'fORL{ 0'2../ J. 3 ) ~ 7 c.ll\ S~I\J In what capacity are you acting? Signature of Applicant y ~()Ct 0(; rn Address of Applicant 3 ~ Ol- 11 STAT~ R-D HOP t w~ L L" d c. T. l\lt'f. L~ 51 3 DOH-301 (3/93) (First) H 11 L I NR (Middle) tUJt:1 (Last) LIf0N'f Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed O~ I 0 4 I 5 Cj (County) (State) What is your relationship to person whose record is requested? If self, state "self." If attorney: Name and relationship of your client to persons whose marriage record is required. tY2 ! (I 109 Please print name and address where record is to be sent. (PLEASE SEE REVERSE SIDE) VS-34M ,...--'-~-"~---- . 'r'\~ 1:~Er"''tt 1"-//" """'\'~:<-'" , ~. , r<,~~ ::> 1o"";~ :c '2~f~~ DRI\'tRLICENSE 10:304 558114 '''"'',,,,.....;.; ~-;'~'* ,.,,(...._1<"'" "~":. -,c' . ..01tC I ,. .,.-~-;,.",,~' - ~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town Clerk for Co of Marria e Record .........,................................ .. ......... ."...... .....,...,........... .......... ............"............ . ..........,....................... .......... .............. '" ................. .. .rnllllffi!BII~lg.:.Q~I~III.<gl:ipkl"il..:.::U Search and Certification Search and Certified Copy D Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. ~ee$10.00 ~ ~er copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. ..................:.:.::.:.::::::::::.:.:.:::::...<:}:ueUSASSeS:MRUE$EF()RMANOe&Mlm1SES:::U..::.:::.:U/....>>}:..:...}.:.:::..::.::.: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..................................................................................................................................................... .. .. ........... ............ ......................................................................... FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps. There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits. PLEASE PRINT OR TYPE Name (First) of "'1'-- ~ I Groom 1/ C\" , (J Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was Issued (Middle) (Last) t\"~ '( k- 4-l-/17Z (State) l) (County) +-~ess N ! J. ~ ,,() . (First) -TIll (Middle) (Last) C""' f; ~-f;lV1r Name of Bride Bride's Age or Date of Birth Residence (County) ~fride Dv -J-Chei-:; If Bride Previously Married, State Name Used at That Time Place Where Marriage Was ~()i.,vtl -J-Id) 1.1(jl),f)(\t, e(~ Fa/J~ Performed f C; I V"( /. ., q --/Lr- 77 (State) ;</ For what purpose is information required? What is your relationship to person whose record is requested? r '). , r /" ~ ~ "0 ~./ c.l'r/D If self, state "self." ('"A , r ~l- I ^j .{{J i s.efa,yten /1/ ^~a. f'J-f"'O'v ~ r- In what capacity are you acting? Address of Applicant 4 LouJe~ .Hf'flfY ~1reef UJ fA ~~I {\ .(J/'S Fed' f / tlY /2 ~Cf 0 DOH-301 (3/93) If attorney: Name and relationship of your client to persons whose marriage record is required. Date 2-/; --oB Please print name and address where record is to be sent. RECEIVED FEe i (PLEASE SEE REVERSE SIDE) TOWN CLERK VS-34M ., _._,---_.,.~"'""_.~,._-~-_..-._~~~~..----~._-'.,......,...".-._'- .- N,~.'r .;141 '\/0.. . D....... . If ..."'''''''..~. --" ;;.......'....."fV lV..t~y . .i. .,~. .... > .... ,'i"" ........ ........ .......... . ." rOf~ve~ ~".I.JLENS'E .1~..".".......5"."7 . .'..,/' '" .V""',,(, 'T~ "\". ....... ... .,y.: .....JiIf). I. .'..... ......>., ......./f,. .' >...... . "',.~~.' ,"_;\"-;':\"f:- /;:~',-,..,r(.,.'.. .~7t., I U"~. .m46380J ......"~ ,"3/ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town Clerk for Co of Marria e Record . .......... ............<...)<<<.iiH.rnI'Rlg.IB:lgllll~I~IIQ~lligil"@}.................................. .........................................."...... ..........,.....................,.................. .................................................. ................."................................ .................................................. .........,......,.................................. .................................................. .... .............................................. .............................................,........ ............................. ..... ........ ...... ............. .................................... .........................".."............,....... .... .......,............................. ,.... ... ............. .................. . . ..... ................... . . Search and 0 Certification Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Search and Certified Copy D Fee$10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. .. . .......................>...........<<......}})I~llligg:!H~IJ;li~IIMINIBIM!!:II~~.:..:C...i)i< FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps. There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits. PLEASE PRINT OR TYPE Name (First) of Groom Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where License Was Issued --'0\...0 ~) (Middle) k';"- \ -ole;; c For what purpose is information required? \~C\ Q~C\( \=l~, In what capacity are you acting? \l/ Name (First) (Middle) of Bride Bride's Age or Date of C') \ lJ . """' Birth '-/\,... '"(- ~ U Residence (County) of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (Last) (State) What is your relationship to person whose record is requested? If self, state "self." ~)\Y- If attorney: Name and relationship of your client to persons whose marriage record is required. Please print name and address where record is to be sent. . LQQ VS-34M _~tL (PLEASE SEE REVERSE SIDE)RECEIVED JAN 3 1 2008 DOH-301 (3/93) TOWN CLERk . . ~ I I I h~i CLA'SS '1) ;.~.__._...-_~,___,_.____________._.,_..........c_._,.~..,--._ ~ j J" NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town Clerk for Co of Marria e Record !Mftil:ftllllll.ili!~III.(gM~9~lni). ......................"............... ....................................... ,.............."...................... . . . . . . . . . . . . . . . . . . . . . , . . . - . . . . . . . . . . . . . ....................................... . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . , . ...................................... . . . . . . . . . . . . . . - . . . . . . . . . . - . . . . . . . . . ' . . . ....................................... . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . ................................ ... ........................... ........................ . . . . . . . . . . . . . . . . . . . Search and 0 Fee $1 Search and D Fee $1 Certification 0.00 Certified Copy 0.00 per copy per copy A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information under the seal of the Health Department, includes the names of occurnng on the original record of the marnage. the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of groom. parentage and certain other detailed information may be required such as: passports, veteran's benefits, court A Certification may be used as proof that a marnage occurred. proceedings, or settlement of an estate. ).:.:pilllil.lt..iltstiilIN:A. lisaNtl.lii. . . . . . . . . . .. ............................................................................... ... ......................................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................~.................................... ............ ". .............................,........ .................................. .................. ...................................................... .................................................... ......................................................." .......................... ......................... ...................................................... ................................................. ..................................... . .......................... ..... .............................. ......................... . . . . . . . . . . . . . . . . . .. .. FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps. There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits, PLEASE PRINT OR TYPE Name (First) of ~. Groom 'fi,-", Groom's Age or Date of ..... ~ \ , Birth ' Residence (County) ~room)U+( 1\< \ , Date of Marriage or Period Covered (..~t {\ i \ \ by Search . '+" Place Where License Issued \ C.. Name of Bride '\, . Bride's Age or Date of Birth ,Y\C l( C t\ l ,~ Residence (County) of. Bride . ~t If Bride Previously Married, State Name Used at'That Time . . Place W Marriage Was \ Performed 'v \ \::.r;: (First) (Middle) (Last) '>C.tv' \ \ k (Middle) (Last) ~.. II '\ $ \r ",., . "' .,-XJ , \ Cll <1 (State) ,Cj11 (State) \ dS. :)06 ~, _.._~ " For what purpose is information required? 1\ \(w\'<, 9 {C\ ~Ct'", rhr l '\\Ie n t.:;. What is your relationship to person whose record is requested? If self, state "self." , ,,'- ,'~' \ i :"'5 \.\ In what capacity are you acting? If attorney: Name and relationship of your client to persons whose marriage record is required. /~ , ( L Address of Applicant ':-:> IlC) \/Jf'.:;;\- 'f\:. ;W"\ ~ T vJC\.~ \\'j<' ,{ ~ F Cl \\ ~ /1 (- \-"' Cq::r\:) N j \-25C) 0 DOH-301 (3/93) (PLEASE SEE REVERSE SIDE) X=.''\I ~$ C " 111) VS-34M \l>-~ ~ C~?-'f.. . {At \ 61 q ~ ~o~ ~~~ .. NEWYORK STATE DEPARTMENT OF HEALTH Vital Records Section Search and Certification D Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Application to Town Clerk for Co of Marria e Record t71' Fee $10.00 bLJ per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. Search and Certified Copy A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. . ...................................................... . .. ............................................. ............................................ ............................................ . ......................................... ....................................... . . . . . . .. ........... - . . . . . . . . . ..............-.............. . . . . . . . . . . . . . . . . , . . . . . . . ...................... . . . . . . . . . . . . . . . . . . .................... ................................ ............................... ............................... ..........................,...................................... ,..p.....'..-' .,............, ,............ .....................................P.... ......... ........... ,. ,...' ............................................. ............................... ............................... ......P....,.....",.......... ............... .................................p.....u.......e.....A......S...;........C....O.......M;.......P...I1.....e....T....S.........p....O.......S.....M...........A......N.....O..........e......e......U.................6....;....&:......................................................................................................................................... ................ .. ... . .. . .' .. .. . . .... .. ... .... .......................................................................... . . . . . . . . . . . . . . , . . .. . . . .. . - .' . . . . .. . . . . . . . . .. . ' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................ .. .... . ......... . . ... ... '. .... .. ." ......... .. .. ... ... ... .................................................................................. . . . . . . . . . . . . . . . .. . . ... .. .. .. ... . . . ... . . . . . . . . .. .. .. . ... . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ., . . .. ... . . . . . . . . . . . . . . . . . . ... . .. ... . . . .. . . . . . .. . . .' . .. . . . .' . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . , . . , . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . , . . . . . . . . . ................. ..... ' ....... . .......... ... ... ." p...... ... . .............................. ............................... .......... . ................... ..... . ..... . .. .. ... . .... .. .' .. . ...... .......... .................................................................... .................... .. ........ ........ .. .. . .... ....... .................................................... .................. ............ .,........ .... .... .. ...... .............................................. . . . . . . . . . . .. ....... . . . .. .,... ............... . . . . . . . . . . . . . . . .. ........ ..... .... .. ... . .......... .. . .. .. ........ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . ... .............................................,...............................................-........,.....'......................................................... ...... .......................................................................................................................,........................................ ........................................................................................................-..... .... FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps. There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits. PLEASE PRINT OR TYPE Name (First) (Middle) of Groom Groom's Age or Date of Birth Residence (County) of Groom Date of Marriage or Period Covered by Search Place Where License Was Issued (Last) (State) In what capacity are you acting? Name (First) of \ Bride 0. tnenlJ Bride's Age or Date of Birth Residence of Bride b Ll ~ If Bride Previously Married, State Name Used at That Time Place Where Marriage Was_ Performed \ 0 W (\ (Middle) (Last) (State) L If attorney: Name and relationship of your client to persons whose marriage record is required. Address of Applicant DOH-301 (3/93) Please print nam and address where record is to be sent. Cc(\-~_e n~ e <O'M, \J00 Bv\ I'd )..Jz 5~fI~3 .~"ee: \ 'No \ '(\C(.r5 Fe", \ \:os NY \2 ') Gf b VS-34M (PLEASE SEE REVERSE SIDE) T'<~\ <T ~:_'i:~_ ,f'" ~.L -:,.; ~);. ';-ij i 10:284054958 DQB::()4.-04;07 VQNBURG;CATHERINE,M 42'SPAINGstkEET 'WAPPfNGERSlFLSNY '12590 SEX:'F EYE$:BR, HT5-05 CLASSiO 'E: ,R; " , ' ISSU~ "20-04' EXPIRES 04-04-09 (~7f/{h ~77460 , NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Search and Certification O Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties. their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. Application to Town Clerk for Co of Marria e Record Search and Certified Copy Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. .... ...........00.00.0..0""0:00000<:::::::;:::::::;:::;:::;:::::0::0:0::::::::::0:::::0:0:::;:::::::::;:<:::::::::;:0'0'0'0:0<:::;:0'0'0'>o-oo:"",o,oo"o,o<:::oo,o,o,}o,o,oo:oo,oo:oo,oooo"ooo,>::o,o"ooo"o,o,oS,o<"::;:'o,o,o:oo'o,ooooo,o,o,oo"::o,o'::;:'I/,}o,oo:,oo'0",o':-:-:;:::'80'o<oo:.S"'o,o:.,."o,o:,o<J'OOO'O'O-OO:::p'O'O'O'O'O'O'O'Os"<'<::;::0:::::0:::::0:::::0:0: ::::::::::::::::000:::::::::::::::::00::::;:::;:::::00..:::0:::::::::::.:.::::::::::::::::::;:::::. :: .....................................PkoE..:oJl;:SE....~:^,*oltft.:o:o:S'~ ....~^m:M... ."1. ... .. .:m.. '''E'' ............................................... ......... ................. ... ......:-:-:-.<:--::::::::::::::::::::::t)}r~{ .:::::~~~. ::~.:' .". . ":~:~:~Q=-.r:" .' <t~:~ "'):f?::yn.. .){ .:. 'J~ ::: )~: .:: ~ ..: . ..: ::~.~{:. .:::::. . :::. :...<{<?{{:>}>}~:)::::::::::::::::::::::::}::::::::::::::;::::::-:-:::-:-:-:.:..-:-:...... ..... .... . ....................................................................... .................... .................................... .......... ............. . .........................-.......................................................................................................................... .. . .............................................................................................. .... . FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps. There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits. PLEASE PRINT OR TYPE Name (First) of .-r- Groom '0 Groom's Age or Date of I l Birth Residence of QI c..' Groom~..J I \.::::' Date of Marriage or Period Covered by Search Place Where License Was Issued (Middle) (Last) Lee_ i d '-l~~ (State) r 112 19DCYJ For what purpose is information reK~?C' ~ 'e \~ MI: EIVED JAN - 9 2008 In what capacity are you acting? TOWN CLERK 3~ \) (}./"'\ VDK 0l.t .~n ycl Dr. loL~.D 1 DOH-301 (3/93) Name (First) (Middle) ~fride C( L ~ -' Bride's Age or Date of Birth Residence (County) of --1 Bride ~ If Bride Previously Married, State Name Used at That Time D ' Place Where Marriage Was \J t lla ~, Performed I -/3 (State) What is your relationship to person whose record is requested? If self, state "self." 5 f' _ \ .~ If attorney: Name and relationship of your client to persons whose marriage record is required. Please pr VS-34M (PLEASE SEE REVERSE SIDE) ck flJ{) 6'9 ------ , NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town Clerk for Co of Marria e Record Search and Certificalion D Fee $10.00 per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Cerlificalion may be used as proof that a marriage occurred. Search and Certified Copy 121 Fee $10.00 per copy A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed informalion may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. .................................. .................................. .................................... .................................... .................................... .................................... .................................... . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . .. . . .......................... . .............. . .............."..................-...........................................................................................-.. ....................................................................................................'.......... ....................................................... ......-_... .... ................................................................................,........,.,..................,......................................,....... ........ ..............................................................................................................p......U.......S............8.....S........0.. ..O................p..m......e.....m....e.........p....O.......S.....NI..........I....N.......O.........R......e......M......l.m........6...S....S....................................................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .. . . . . . .' . . , .' . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ..........................................-........... .... ... .... ... ... . ... .' .. . .. . .................................... . ..................................,............... .. .... . . ......... . . .. ... . .... .. ... ......... .. ". ... ... ... ...............................,........., . .................................... ..... ..... ...... . ............ .. ....... ... ............................... ..... ... ................................... .. .. ........ ........ ...... .. .. ... . . ...................................... ................................... ...... ... . ... . .... ........ .. ." ....... .... .. ..................................... ............................-.. ... .. ... .. ..... . .. .. ... . .... .. .' .. . .... .. .. ... ... ... ...................................-.... . . . . , . . . . .. .,............ ... . . . . . .. . . . .. ... . . . . . . ... . . ." . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . .. ... . . . . . . . ." . . .' . . . . . . .' . . . .. . .. . .. . .. ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . ............... ...... .... .... ........ ...... ...... ..............,...... ..... ........ . .... ........... .... ............................ ...,.............~....................................................,...........,............................-........................................ .. .. . . . . . . . . . . . . .. ....................................... - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . .................................................................................................... ............,..................-.... ........"........................ ... .................... .. ,................. FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps. There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits. PLEASE PRINT OR TYPE Name (First) of It\\<::..:.--rA,-....A Groom ~,) \ r r Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered .{ 1(FJ ( J r/J6 by Search Place Where License Was Issued (Middle) (Last) J.o~^C( t?- (1S 119:)-1 (State) (County) 1JU TCl-(E So S wA'\'~ (\J G:t'i?- (First) 'LA\lfe\{~ (Middle) <;;kM (Last) PA'le (C \L Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed D? / ()<{ ( .19; .:r-b (County) (State) rJ'''-t \)1...\ \' c.JJF~ 5 7DLJ~ o{7 CL-i~7D\."j :VAQ\L In what capacity are you acting? ~)~~E:-- TOWN CLERK F(s~u ~ 1)r\!~ .Y,1~b I L S-tJ DOH-301 (3/93) What is your relationship to person whose record is requested? If self, state "self." ~'f'0\.1 ~ E If attorney: Name and relationship of your client to persons whose marriage record is required. 01 (0 t (1-00/1 Please print name and address where record is to be sent. ~ Us r A~ A j-Dt:.-M A:-c""A. g G (c2.l2..i\. '^ 't \,\ P r j v€ h-rL 19 t 'u...)..Y-1 41 S 2- VS-34M (PLEASE SEE REVERSE SIDE) .., -, _...'- " . " -,'. ......--'..- ......,~_.,__<-.c-.,..._<,...:.-.~;;~~~~~_____~_~~______..~_.._:-"'.'-'-~"""'-~'"'..:,"" NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for Coe.y of Marriage Record Search and D Certification Fee $10.00 per copy A Cerlificallon, an abstract from the marriage record Issued under the seal of the Health Department, includes the names of the contracllng parties, their residence at the time the license was Issued as well as date and place of birth of the bnde and groom. A Certification may be used as proof that a marnage occurred. r7f Fee $10.00 ~ per copy A Certified Transcnptlncludes all of the items of Information occurnng on the onginal record of the marriage. Search and Certified Copy A Certified Transcript may be needed where proof of parentage and certain other detailed Information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate PLEASE PRINT OR TYPE Name (First) of tJI .. ,~ Groom '" \ I c.hGle. . -r 0) r\C,.;-..s Groom's Age ( I or Date of q.3 0 5' Birth Residence of Groom Date of Marnage or Penod Covered '0 I, ~ \ \t\ e s by Search Place Where \ _I' Fe \\& License Was V'I d pp' Y'\Cj.er.$ Q \ Issued 0 (Middle) (Last) "-, \, (County) (State) M .'del MA ~v (First) Morae) (Middle) Ann (l.ast) tl\o 0 E'flS Name of Bnde Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed 4> I ' 4 \ $3 (State) (County) tJ\ "'d.d.l~ $C...)( J'\A For what purpose is Informallon required? What IS your relationship to person whose record IS requested? 'P~~fof':t-)-~-. ..______~______ Ifself,state"self." S~\b __ In what capacity are you acting? .. _Se, \-\) If attorney: Name and relationship of your client to persons whose marriage record IS required. Slm~o=cthcoeu c//dI Address of Applicant 55 "R(U.( N\O~ W4~ Ash\Qnd, 1M 0' ~~ I DOH-301 (3/93) Please pnnt name and address where record is to be sent Mc)'C.,"d \.h'\~ W SS- R!U1 f"I\ 0 t"aCl tJJ.f Ash\tUlel 0 \ =I-~I (PLEASE SEE REVERSE SIDE) RECEIVED JAN - 7 2008 TOWN CLERK EX/' D09 oe~1~201 0 06.14.1 CU$fJaEST HOT sex o B 5-04f HILL MARCIA MOOERS 55 RAYMOND WAY ASHLAND, MA 01721-2431 Marcia Mooers Hill 55 Raymond Way Ashland, MA 01721 January 2, 2008 Clerk's Office Town Hall 20 Middlebrush Road Wappingers Falls, NY 12590 To Whom It May Concern: Please send me three (3) copies of the Certified Transcript of my marriage record. The marriage license was issued in the town of Wappingers Falls, New York and the marriage took place in poughkeepsie, NY on October 12, 1985. Enclosed is a check for $30.00. Please feel free to contact me at (508) 881-4347 if you have any questions or concerns. Sincerely, Jllti Ult.J1ia'l ~i; Marcia Mooers Hill COMMONWEALTH OF MASSACHUSETTS ~ 1 · On this cJ. day of qf\ \ . 'j;L'-/'I / 2008, before me, personally appeared Marcia Mooers Hill, proved t me -'J'rou9rrsatisfactOry evidence of identification, which was a Massachusetts Driver License, to be he person whose named is signed on the preceding or attached documents, and acknowledged to me that she signed it voluntarily for its stated purpose. ,~ . - - (i(@DARAS'WEINIERGER l NotIry Public ~ Commanwe... of ........... __ My CCllllllllui6n E.llpha ..., 14, 20111 -- - Notary Public (seal) My commission expires: ~ I~ 1;010